摘要
目的观察吸入低浓度(1.0%~2.5%)七氟烷并保持脑电双频指数(BIS)为45~55对合并冠心病的非心脏手术患者围术期的心肌保护效应。方法选取100例合并冠心病的非心脏手术患者作为研究对象,采用随机投掷法分为A组、B组、C组,3组麻醉诱导方案相同。A组未吸入七氟烷,保持BIS为35~44;B组吸入2.6%~4.0%七氟烷,保持BIS为35~44;C组持续吸入1.0%~2.5%七氟烷,并保持BIS为45~55。结果3组患者手术时间、术中出血量、术中补液量比较,差异无统计学意义(P>0.05);C组低血压、心动过缓及心肌缺血的发生率低于B组,差异有统计学意义(P<0.05);麻醉诱导前、插管时,3组患者心肌肌钙蛋白T(cTnT)、超敏C反应蛋白(hs-CRP)水平比较,差异无统计学意义(P>0.05);拔管即刻,C组cTnT、hs-CRP水平低于A组、B组,差异有统计学意义(P<0.05)。结论吸入1.0%~2.5%七氟烷并保持BIS为45~55,可改善合并冠心病的非心脏手术患者的围术期心肌保护效果,并降低心血管不良事件的发生率。
Objective To analyze the effect of inhaling sevoflurane at concentration of ranging from 1.0%to 2.5%and maintaining Bispectral Index(BIS)of 45 to 55 on perioperative myocardial protection in coronary heart disease patients with non-cardiac surgery.Methods A total of 100 coronary heart disease patients undergoing thoracoabdominal surgery were selected and divided into groups A,B,and C according to random throwing method.The three groups had the same induction protocol,and group A was not given sevoflurane inhalation,with BIS of 35 to 44,group B was given sevoflurane inhalation at concentration of 2.6%to 4.0%,with BIS of 35 to 44,group C was given sevoflurane inhalation at concentration of 1.0%to 2.5%,BIS maintained 45 to 55.Results There were no significant differences in the operation time,intraoperative blood loss,and intraoperative fluid replacement volume among the three groups(P>0.05);the incidence rates of hypotension,bradycardia,and myocardial ischemia in the group C were significantly lower than those in the group B(P<0.05);there were no significant differences in cardiac troponin T(cTnT),hypersensitive C-reactive protein(hs-CRP)levels before intubation and at intubation in the three groups(P>0.05);cTnT and hs-CRP levels in the group C were significantly lower than groups A and B at extubation(P<0.05).Conclusion Sevoflurane inhalation at concentration of 1.0%to 2.5%and maintaining BIS of 45 to 55 can improve the efficacy in protection of perioperative myocardium in non-cardiac surgery patients with coronary heart disease,and can reduce the incidence of cardiovascular adverse events.
作者
吴绪才
高子军
肖莉
董补怀
WU Xucai;GAO Zijun;XIAO Li;DONG Buhuai(Department of Anesthesiology,Red Cross Hospital Affiliated to Xi′an Jiaotong University,Xi′an,Shaanxi,710054)
出处
《实用临床医药杂志》
CAS
2020年第23期70-72,91,共4页
Journal of Clinical Medicine in Practice
基金
陕西省卫生和计划委员会课题(S2016TFSF0376)。
关键词
七氟烷
非心脏手术
冠心病
心肌保护
麻醉诱导
拔管即刻
脑电双频指数
sevoflurane
non-cardiac surgery
coronary heart disease
myocardial preservation
anesthesia induction
time point of extubation
Bispectral Index
