摘要
目的探讨七氟烷全程吸入麻醉对行非体外循环冠脉旁路移植术（OPCABG）患者血液动力学和心功能的影响。方法选择拟行择期OPCABG的ASAⅡ-Ⅲ级患者40例,随机分为丙泊酚全凭静脉麻醉组（Pro组）和七氟烷全程吸入麻醉组（Sevo组）,分别以丙泊酚和七氟烷维持镇静,舒芬太尼和维库溴铵维持镇痛和肌松,术中维持BIS值40~50。分别于诱导前（T1）,插管后（T2）,锯开胸骨（T3）,第一支桥血管吻合（T4）,最后一支桥血管吻合（T5）,关胸骨（T6）,手术结束（T7）,入ICU即刻（T8）记录血液动力学参数。经食道超声心动图观察术中室壁运动情况,双平面碟片法测量CO、SV、EF、FS等。结果两组患者术中血液动力学参数组间比较无显著性差异,但七氟烷组波动较小。两组患者心功能指标组间比较,Sevo组较Pro组术后增高有统计学差异（P〈0.05）。Sevo组组内比较,术后较术前增高有显著性差异（P〈0.05）。结论七氟烷全程吸入麻醉用于OPCABG手术较全凭静脉麻醉具有一定优势,可减轻血液动力学不稳定和心功能的抑制。
【Objective】 To investigate the influence of volatile induction and maintenance of anesthesia with sevoflurane on hemodynamic parameters and cardiac function in patients undergoing off-pump coronary artery bypass grafting surgery.【Methods】40 patients classified ASA II-III undergoing OPCABG surgery were randomly divided into two groups（n =20）.Group Pro received propofol intravenously and group Sevo received sevoflurane inhalation as sedative anesthesia.Both of the two groups received sulfentanil and vecuronium as narcotic and muscle relaxant.The depth of anesthesia maintained at BIS 40 ～50.Hemodynamic parameters were recorded at T1（before anesthesia induction）,T2（after intubation）,T3（opening chest）,T4（after the first vessel grafted）,T5（after the last vessel grafted）,T6（closing thorax）,T7（the end of operation）,T8（ICU arrival）.Left ventricular regional wall motion was monitored by transesophageal.Cardiac output and ejection fraction measurement were assessed using two-dimensional echocardiography.【Results】There was no significant difference in hemodynamic parameters between two groups,but the hemodynamic was more stable in group Sevo.The postoperative cardiac function in group Sevo was significant higher（P 0.05） than that of postoperative in group Pro and that of preoperative in group Sevo.【Conclusion】Volatile induction and maintenance of anesthesia with sevoflurane has more advantages for patients undergoing OPCABG surgery than total intravenous anesthesia with propofol.Sevoflurane VIMA has less hemodynamic instability and cardiac function inhibition.
出处
《中国现代医学杂志》
CAS
CSCD
北大核心
2013年第6期62-65,共4页
China Journal of Modern Medicine
关键词
七氟烷
吸入麻醉
非体外循环冠脉旁路移植术
心功能
sevoflurane
inhalation anesthesia
off-pump coronary artery bypass graft surgery
cardiac function
