摘要
目的:对比丙泊酚单用及七氟醚复合丙泊酚维持麻醉在老年二尖瓣置换术中的价值,观察不同方案对患者心肌损伤的影响,指导老年二尖瓣置换手术麻醉维持药物的选择。方法:收集2018年3月~2019年12月本院接受二尖瓣置换术老年患者(76例)病历资料,进行回顾性分析。其中,单用丙泊酚[1.5~2μg/ml(血浆靶控浓度)输注]维持麻醉的38例老年患者纳入对照组;同期使用七氟醚(0.5最低肺泡气有效浓度补充吸入)复合丙泊酚[1.5~2μg/ml(血浆靶控浓度)输注]维持麻醉的38例老年患者纳入观察组。对比两组麻醉诱导前(t0)、主动脉开放后30 min(t1)、6 h(t2)、24 h(t3)的心肌损伤[心肌肌钙蛋白I(cardiac troponin I,cTnI)、肌酸激酶同工酶(creatine kinase isoenzymes,CK-MB)、丙二醛(malondialdehyde,MDA)、超氧化物歧化酶(superoxide dismutase,SOD)]标志物水平变化情况,记录两组手术相关指标,记录两组术后心血管不良事件发生情况。结果:两组t0时的cTnI、CK-MB、MDA和SOD水平对比,无统计学差异(P> 0.05);观察组t1、t2和t3时的cTnI、CK-MB和MDA水平均低于对照组,SOD水平高于对照组,有统计学差异(P <0.05);观察组的意识消失时间、机械通气时间、重症监护治疗病房(ICU)停留时间及住院时间均短于对照组,有统计学差异(P <0.05);观察组的室性心律失常、心脏停搏和心力衰竭发生率均低于对照组,有统计学差异(P <0.05)。结论:七氟醚复合丙泊酚在老年二尖瓣置换术维持麻醉中的应用效果较单用丙泊酚好,更利于减轻老年患者心肌损伤程度,患者机械通气时间、住院时间等均缩短,且术后不良心血管事件减少,更利于术后康复,临床应用价值更高。
Objective:To compare the value of propofol alone and sevoflurane combined with propofol maintenance anesthesia in senile mitral valve replacement,to observe the effect of different schemes on myocardial damage of patients,and to guide the choice of anesthesia maintenance drugs for senile mitral valve replacement.Methods:The retrospective analysis was performed on the medical records of 76 senile patients who underwent mitral valve replacement in the hospital from March 2018 to December 2019.38 patients received propofol alone[1.5~2μg/ml(plasma target controlled concentration)infusion]maintenance anesthesia were included in the control group.And 38 patients received sevoflurane(0.5 minimum alveolar gas effective concentration supplemental inhalation)combined with propofol[1.5~2μg/ml(plasma target controlled concentration)infusion]maintenance anesthesia were included in observation group.The changes of myocardial damage markers[cardiac troponin I(cTnI),creatine kinase isoenzymes(CK-MB),malondialdehyde(MDA),superoxide dismutase(SOD)]before anesthesia induction(t 0),after aortic artery opening for 30 min(t 1),6 h(t 2),24 h(t 3)were compared between the two groups.The surgical indexes,incidence of adverse cardiovascular events after surgery of two groups were recorded.Results:There was no statistical difference in the levels of cTnI,CK-MB,MDA and SOD between two groups at t 0(P>0.05);The levels of cTnI,CK-MB and MDA in observation group were lower than those in control group at t 1,t 2,t 3,and the level of SOD in observation group was higher than that in control group(P<0.05);The unconscious time,mechanical ventilation time,ICU stays and hospital stays in observation group were shorter than those in control group(P<0.05);The incidence of ventricular arrhythmia,sudden cardiac arrest and heart failure in observation group was lower than those in control group(P<0.05).Conclusion:The application effect of sevoflurane combined with propofol maintenance anesthesia in senile mitral valve replacement is better than that of
作者
尚艳伟
张睿
杨祖悌
SHANG Yan-wei;ZHANG Rui;YANG Zu-ti(Department of Anesthesiology,Nanyang Nanshi Hospital,Nanyang 473000,China)
出处
《中国合理用药探索》
CAS
2021年第1期86-90,共5页
Chinese Journal of Rational Drug Use
关键词
二尖瓣置换术
七氟醚
丙泊酚
心肌损伤
心血管不良事件
mitral valve replacement
sevoflurane
propofol
myocardial damage
adverse cardiovascular events
