文献类型：期刊文献

中文题名：吸入不同浓度七氟烷麻醉对冠心病患者非心脏手术围术期心肌功能的保护作用探讨

英文题名：The Protective Effect of Inhaled Sevoflurane Anesthesia with Different Concentrations on Myocardial Function in Patients with Coronary Heart Disease During Non-cardiac Surgery

作者：畅艳娜[1];冯秀玲[1]

第一作者：畅艳娜

机构：[1]甘肃中医药大学附属医院麻醉科,甘肃兰州730000

第一机构：甘肃中医药大学第二附属医院

年份：2021

卷号：40

期号：25

起止页码：5

中文期刊名：中外医疗

外文期刊名：China & Foreign Medical Treatment

语种：中文

中文关键词：七氟烷;不同浓度;麻醉;冠心病;非心脏手术;心肌保护

外文关键词：Sevoflurane;Different concentrations;Anesthesia;Coronary heart disease;Non-cardiac surgery;Myocardial Protection

摘要：目的研究吸入不同浓度七氟烷达到不同麻醉深度对冠心病非心脏手术患者围术期心肌功能的保护作用。方法方便选取2018年1月—2019年12月该院收治的210例合并冠心病的非心脏手术患者,随机分为3组:对照组、观察A组、观察B组,各70例。均静脉给予依托咪酯、丙泊酚、顺苯磺酸阿曲库铵、舒芬太尼麻醉诱导和维持,对照组维持BIS在40~50,观察A组给予持续吸入高浓度(2.5%~4.0%)七氟烷,维持BIS在35~45;观察B组给予持续吸入低浓度(1.0%~2.5%)七氟烷,维持BIS在45~55。分别于麻醉诱导前、拔管毕即刻记录心电图,并采集静脉血样检验血清肌钙蛋白T(cTnT)、超敏心肌肌钙蛋白T(hs-cTnT)和超敏c反应蛋白(hs-CRP)水平。结果观察A组、B组心肌缺血发生率分别为25.7%、8.6%均低于对照组的41.4%,差异有统计学意义(χ^(2)=3.876,20.152,P<0.05),观察A组、B组心动过速发生率分别为4.3%、17.1%均低于对照组的31.4%,差异有统计学意义(χ^(2)=17.579,3.887,P<0.05),观察A组、B组房颤发生率分别为2.9%、11.4%均低于对照组的31.4%,差异有统计学意义(χ^(2)=3.878,3.878,8.315,P<0.05),观察A组、B组高血压发生率分别为4.3%、15.7%均低于对照组的32.9%,差异有统计学意义(χ^(2)=18.893,5.594,P<0.05),观察A组、B组期前收缩分别为17.1%、5.7%均低于对照组的32.9%,差异有统计学意义(χ^(2)=4.610,16.565,P<0.05);观察A组心动过缓、低血压的发生率(38.6%、38.6%)高于对照组(8.6%、10.0%)和观察B组(22.9%、22.9%),差异有统计学意义(χ^(2)=17.485、4.061、15.583、4.061,P<0.05);观察A组心肌缺血的发生率为25.7%高于观察B组的8.6%,差异有统计学意义(χ^(2)=7.241,P<0.05)。3组麻醉诱导前的血清cTnT、hs-cTnT和hs-CRP水平比较,差异无统计学意义(P>0.05);拔管毕,观察A组、观察B组的血清cTnT(98.22±10.43)、(98.79±11.38)ng/L、hs-cTnT(11.34±1.31)、(9.16±1.35)ng/L和hs-CRP水平(2.06±0.24)、(1.91±0.22)mg/L均明显低于对照组,差异有统计学意义(P<0.05),且观察B组的血清hs-cTnT(9.16±1.35)和hs-CRP水平(1.91±0.22)低于观察A组,差异有统计学意义(P<0.05)。结论吸入七氟烷麻醉对冠心病患者非心脏手术围术期心肌功能可起到明显的保护作用,吸入低浓度(1.0%~2.5%)七氟烷维持BIS在45~55所起到的保护作用更佳。
Objective To investigate the protective effects of inhaled different concentrations of sevoflurane anesthesia on perioperative myocardial function in patients with coronary heart disease during non-cardiac surgery.Methods Convenience selected the hospital from January 2018 to December 2019,210 patients with coronary heart disease undergoing non-cardiac surgery were randomly divided into control group(n=70),group A(n=70)and group B(n=70).Anesthesia induction and maintenance by intravenous administration of etomidate,propofol,atracurium cis-benzenesulfonate and sufentanil.BIS was maintained at 40-50 in control group,sevoflurane(2.5%-4.0%)was inhaled continuously in group A,and BIS was maintained at 35-45 in group A.Group B was given continuous inhalation of low concentration sevoflurane(1.0%-2.5%)to maintain BIS at 45-55.Recorded electrocardiograms before induction of anesthesia and immediately after extubation,and collected venous blood samples to test serum troponin T(cTnT),high-sensitivity cardiac troponin T(hs-cTnT)and high-sensitivity c-reactive protein(hs-CRP)level.Results The incidence of myocardial ischemia in group A and Group B was 25.7%and 8.6%,respectively,lower than 41.4%of the control group,the difference was statistically significant(χ^(2)=3.876,20.152,P<0.05).The incidence of tachycardia in group A and group B was 4.3%and 17.1%,respectively,lower than 31.4%of the control group.The difference was statistically significant(χ^(2)=17.579,3.887,P<0.05),the incidence of atrial fibrillation in group A and group B was 2.9%and 21.4%,respectively,lower than 31.4%of the control group,the difference was statistically significant(χ^(2)=3.878,8.315,P<0.05).The incidence of hypertension in group A and group B was 4.3%and 15.7%,respectively,lower than 32.9%of the control group,the difference was statistically significant(χ^(2)=18.893,5.594,P<0.05),the prephase contraction of group A and B was 17.1%and 5.7%,respectively,lower than 32.9%of the control group,and the difference was statistically significant(χ^(2)=4.610,16.565,P<0.05).The incidence of bradycardia and hypotension in observation group A(38.6%,38.6%)was higher than that in control group(8.6%,10.0%)and observation group B(22.9%,22.9%),the difference was statistically significant(χ^(2)=17.485,4.061,15.583,4.061,P<0.05).The incidence of myocardial ischemia in group A was 25.7%higher than that in group B 8.6%,the difference was statistically significant(χ^(2)=7.241,P<0.05).There was no statistically significant difference in serum cTnT,hs-CTnt and Hs-CRP levels among 3 groups before anesthesia induction(P>0.05).After extubation,the serum cTnT(98.22±10.43)ng/L,(98.79±11.38)ng/L,hs-CTnt(11.34±1.31)ng/L,(9.16±1.35)ng/L and hs-CRP levels(2.06±0.24)mg/L,(1.91±0.22)mg/L in group A and group B were significantly lower than those in control group,the difference was statistically significant(P<0.05),and the serum hs-CTnt(9.16±1.35)ng/L and hs-CRP levels(1.91±0.22)mg/L in observation group B were lower than those in observation group A,the difference was statistically significant(P<0.05).Conclusion Inhalation of sevoflurane anesthesia can significantly protect perioperative myocardial function in patients with coronary heart disease during non-cardiac surgery,and low concentrations(1.0%-2.5%)of sevoflurane have a better protective effect on maintaining BIS between 45 and 55.