七氟醚与丙泊酚麻醉对老年冠心病非心脏手术患者血流动力学心肌保护及不良事件的影响

doi:10.3969/j.issn.1006-6233.2022.02.030

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摘要 目的: 探究七氟醚与丙泊酚麻醉对老年冠心病非心脏手术患者血流动力学、心肌保护及不良事件的影响。方法: 选择2017年9月至2020年9月我院收治的132例老年冠心病患者作为研究对象,简单随机分组将其分为七氟醚组(n=66例)与丙泊酚组(n=66例),行非心脏手术时分别使用3%七氟醚持续吸入与3μg/mL丙泊酚持续输注进行麻醉。比较两组患者手术情况、心肌标志物、血流动力学参数、心脏不良事件及其他不良事件发生情况。结果: 七氟醚组患者清醒时间、拔管时间及输液量显著少于丙泊酚组(P<0.05);术后即刻,七氟醚组心肌肌钙蛋白I(cTnI)水平显著低于丙泊酚组(P<0.05),术后12h及术后24h,七氟醚组cTnI及肌酸激酶同工酶(CK-MB)水平显著低于丙泊酚组(P<0.05);T1时,七氟醚组SBP水平显著高于丙泊酚组(P<0.05),T2时,七氟醚组心率(HR)水平显著低于丙泊酚组,收缩压(SBP)水平显著高于丙泊酚组(P<0.05),T3时,七氟醚组SBP水平显著高于丙泊酚组(P<0.05),T4时,七氟醚组HR水平显著低于丙泊酚组,SBP及舒张压(DBP)水平显著高于丙泊酚组(P<0.05),T5时,七氟醚组SBP及DBP水平显著高于丙泊酚组(P<0.05);七氟醚组心脏总不良反应的发生率为10.61%,显著低于对照组的28.79%;七氟醚组其他总不良反应的发生率为19.70%,显著高于对照组的6.06%(P<0.05)。结论: 七氟醚麻醉在老年冠心病患者进行非心脏手术时有更稳定的血流动力学效应,麻醉与苏醒时间更短,对心肌有更好地保护作用,且输液量与心脏不良事件发生率更低,但易发生恶心呕吐等不良事件,适合有打针恐惧感、潜在气道困难与心脏风险的患者。

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	师高洋
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关键词 ：七氟醚, 丙泊酚, 冠心病, 血流动力学, 心肌保护, 不良事件

Abstract：Objective: To explore the effects of sevoflurane anesthesia and propofol anesthesia on hemodynamics, myocardial protection and adverse events in elderly patients with coronary heart disease undergoing non-cardiac surgery. Methods: A total of 132 elderly patients with coronary heart disease admitted to the hospital between September 2017 and September 2020 were selected as the research subjects, and they were simply randomly divided into sevoflurane group (n=66) and propofol group (n=66), and respectively given continuous inhalation of 3% sevoflurane and continuous infusion of 3 μg/ml propofol for anesthesia during non-cardiac surgery. The surgical status, myocardial markers, hemodynamic parameters and occurrence of cardiac adverse events and other adverse events were compared between the two groups. Results: The awake time, extubation time and transfusion volume of sevoflurane group were significantly shorter or less than those of propofol group (P<0.05). Immediate measure after surgery showed that the level of cardiac troponin I (cTnI) was significantly lower in sevoflurane group than that in propofol group (P<0.05). The levels of cTnI and creatine kinase-MB (CK-MB) in sevoflurane group at 12h and 24h after surgery were significantly lower than those in propofol group (P<0.05). At T1, the SBP of sevoflurane group was significantly higher compared to propofol group (P<0.05). At T2, the heart rate (HR) of sevoflurane group was significantly lower than that of propofol group while the systolic blood pressure (SBP) was significantly higher than that of propofol group (P<0.05). At T3, the SBP was significantly higher in sevoflurane group compared with that in propofol group (P<0.05). At T4, the HR of sevoflurane group was significantly lower while the SBP and diastolic blood pressure (DBP) were significantly higher compared to propofol group (P<0.05). At T5, the SBP and DBP in sevoflurane group were significantly higher than those in propofol group (P<0.05). The total incidence rate of adverse cardiac reactions was 10.61% in sevoflurane group, which was significantly lower than 28.79% in propofol group. The total incidence rate of other adverse reactions in sevoflurane group was significantly higher than that in propofol group (19.70% vs 6.06%) (P<0.05). Conclusion: Sevoflurane for anesthesia has a more stable hemodynamic effect and shorter anesthesia time and recovery time in elderly patients with coronary heart disease undergoing non-cardiac surgery, and it better protects the myocardium and has less transfusion volume and lower incidence of cardiac adverse events. But it is prone to adverse events such as nausea and vomiting, thus it is suitable for patients with fear of injections, potential airway difficulties and heart risks.

Key words： Sevoflurane Propofol Coronary heart disease Hemodynamics Myocardial protection Adverse events

基金资助:海南省卫生计生行业科研项目,(编号:19A200101)

引用本文:

师高洋, 黄良诚, 甘昌材. 七氟醚与丙泊酚麻醉对老年冠心病非心脏手术患者血流动力学心肌保护及不良事件的影响[J]. 河北医学, 2022, 28(2): 322-327.
SHI Gaoyang, HUANG Liangcheng, GAN Changcai. Effects of Sevoflurane Anesthesia and Propofol Anesthesia on Hemodynamics Myocardial Protection and Adverse Events in Elderly Patients with Coronary Heart Disease Undergoing Non-Cardiac Surgery. HeBei Med, 2022, 28(2): 322-327.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2022.02.030 或 http://www.hbyxzzs.cn/CN/Y2022/V28/I2/322

[1] Zhang Y,Lin W,Shen S,et al.Randomized comparison of sevoflurane versus propofol-remifentanil on the cardioprotective effects in elderly patients with coronary heart disease[J].BMC Anesthesiol,2017,17(1):104.
[2] Sashindranath M,Sturgeon S A,French S,et al.The mode of anesthesia influences outcome in mouse models of arterial thrombosis[J].Res Pract Thromb Haemost,2019,3(2):197~206.
[3] Dai Z L,Cai X T,Gao W L,et al.Etomidate vs propofol in coronary heart disease patients undergoing major noncardiac surgery:a randomized clinical trial[J].World Clin Cases,2021,9(6):1293~1303.
[4] 张莹莹,唐菁,刘双双,等.七氟醚不同吸入时长对非心脏手术老年冠心病患者心肌的保护作用[J].重庆医学,2020,49(6):933~937.
[5] 郭靖涛,李文泽,张来军.实用心脏内科学[M].科学技术文献出版社,2013.332~341.
[6] 胡翠纹,郭轩,张琪,等.美国麻醉医师协会体质分级对老年手术患者心脏自主神经功能的评价意义[J].中华老年心脑血管病杂志,2021,23(5):491~494.
[7] 刘乐义,刘子嘉,许广艳,等.修订的心脏风险指数对老年冠心病患者非心脏手术围手术期主要心脏不良事件的临床评估价值[J].中国医学科学院学报,2020,42(6):732~739.
[8] Ren L,Sun X,Guan Y,et al.Effects of sevoflurane or propofol combined with remifentanil anesthesia on clinical efficacy and stress response in pregnant women with pregnancy-induced hypertension.[J].Eur rev med pharmacol sci,2018,22(6):1825~1829.
[9] 国松,姜万维,郭旭东,等.不同靶浓度丙泊酚复合瑞芬太尼与七氟醚复合瑞芬太尼静吸麻醉用于腹腔镜胆囊切除术的观察[J].河北医学,2021,27(1):33~37.
[10] 安彬,陶德强,杨占民.七氟醚复合丙泊酚麻醉对冠心病患者术后血流动力学及NT-proBNP水平的影响[J].中国循证心血管医学杂志,2019,11(8):989~991.
[11] Han Y,Han L,Dong M,et al.Comparison of a loading dose of dexmedetomidine combined with propofol or sevoflurane for hemodynamic changes during anesthesia maintenance:a prospective,randomized,double-blind,controlled clinical trial[J].Bmc Anesthesiol,2018,18(1):12.
[12] 付鹏,马平,李振辉.七氟醚对合并冠心病腹腔镜胆囊切除患者cTnI、GP-BB的影响及预后分析[J].中国医药导报,2018,15(19):109~112.