地氟烷后处理在体外循环心脏手术中的应用研究  

Application of desflurane post-treatment in extracorporeal circulation cardiac surgery

作　　者：王欣 高雁华[1] 赵会奇 WANG Xin;GAO Yanhua;ZHAO Huiqi(Department of Anesthesiology,Anyang People's Hospital,Anyang,Henan 455000,China)

机构地区：[1]安阳市人民医院麻醉科,河南安阳455000

出　　处：《中国医学工程》2025年第4期73-77,共5页China Medical Engineering

基　　金：河南省医学科技攻关项目(2021001152)。

摘　　要：目的观察地氟烷后处理在体外循环心脏手术中的应用效果。方法该前瞻性研究选取安阳市人民医院2022年2月至2024年2月收治的体外循环心脏手术患者为研究对象,从中随机抽取91例,应用电脑随机分组法将其分别列为预处理组(45例)和后处理组(46例),两组均采用地氟烷辅助全身麻醉,预处理组于麻醉诱导前吸入浓度为5%的地氟烷,后处理组于机械通气后吸入浓度为5%的地氟烷,比较两组患者术后镇痛效果、术后镇静效果、术后心肌损伤情况、术后应激情况及麻醉安全性。结果后处理组术后1 h、3 h、5 h的视觉模拟量表(VAS)评分分别为(3.25±0.36)分、(2.55±0.31)分、(2.02±0.41)分,均低于预处理组[(3.72±0.82)分、(3.11±0.76)分、(2.68±0.85)分](P<0.05);术后Ramsay镇静量表(RSS)评分分别为(3.88±0.26)分、(3.31±0.35)分、(3.05±0.33)分,均高于预处理组[(3.23±0.75)分、(2.88±0.72)分、(2.31±0.85)分](P<0.05);后处理组术后肌红蛋白(MYO)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)分别为(60.36±10.32)μg/L、(10.35±2.28)U/L、(40.31±10.28)U/L,均低于预处理组[(65.26±10.31)μg/L、(12.25±3.31)U/L、(45.36±10.22)U/L](P<0.05);后处理组术后去甲肾上腺素(NE)、皮质醇(Cor)、血管紧张素Ⅱ(AngII)分别为(42.31±10.25)μg/L、(282.41±20.44)nmol/L、(27.25±5.28)ng/L,均低于预处理组[(47.26±10.35)μg/L、(296.45±20.41)nmol/L、(30.29±5.31)ng/L](P<0.05)。后处理组的麻醉相关副反应发生率为8.70%(4/46),与预处理组[4.44%(2/45)]比较,差异无统计学意义(P>0.05)。结论在体外循环心脏手术患者实施机械通气后吸入地氟烷可在不增加麻醉风险同时有效增强术后镇痛、镇静效果,对减轻心肌损伤、手术应激均有积极意义。【Objective】To observe the application effect of desflurane post-treatment in extracorporeal circulation cardiac surgery.【Methods】This prospective study randomly selected 91 patients who underwent extracorporeal circulation cardiac surgery in Anyang People's Hospital from February 2022 to Ferburey 2024.They were divided into a pre-treatment group(45 cases)and a post-treatment group(46 cases)using computer random grouping method.Both groups received desflurane assisted general anesthesia.The pre-treatment group inhaled a concentration of 5% desflurane before anesthesia induction,while the post-treatment group inhaled a concentration of 5% desflurane after mechanical ventilation.The postoperative analgesic effect,postoperative sedation effect,postoperative myocardial injury,postoperative stress state,and anesthesia safety of the two groups of patients were compared.【Results】Under different anesthesia regimens,the Visual Analogue Scale(VAS)scores of the post-treatment group at 1 hour,3 hours,and 5 hours postoperatively were 3.25±0.36 points,2.55±0.31 points,and 2.02±0.41 points,lower than the pretreatment group(3.72±0.82 points,3.11±0.76 points,and 2.68±0.85 points)(P<0.05).The Ramsay sedation Scale(RSS)scores were 3.88±0.26 points,3.31±0.35 points,and 3.05±0.33 points,higher than the pre-treatment group(3.23±0.75 points,2.88±0.72 points,and 2.31±0.85 points)(P<0.05).The postoperative myoglobin(MYO),creatine kinase-myocardial band(CK-MB),and lactate dehydrogenase(LDH)in the post-treatment group were 60.36±10.32μg/L,10.35±2.28 U/L,and 40.31±10.28 U/L,lower than those in the pre-treatment group(65.26±10.31μg/L,12.25±3.31 U/L,45.36±10.22 U/L)(P<0.05).The norepinephrine(NE),cortisol(Cor),and angiotensin(AngⅡ)of the post-treatment group were 42.31±10.25μg/L,282.41±20.44 nmol/L,and 27.25±5.28 ng/L,lower than those in the pre-treatment group(47.26±10.35μg/L,296.45±20.41 nmol/L,30.29±5.31 ng/L)(P<0.05).The incidence of anesthesia related recurrence in the post-treatment group was 8.7

关 键 词：体外循环心脏手术 地氟烷后处理 心肌损伤 手术应激 麻醉安全性 

分 类 号：R654.2[医药卫生—外科学]