中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2009年
1期
27-30
,共4页
王洪萌%林财珠%龚捷音%林群
王洪萌%林財珠%龔捷音%林群
왕홍맹%림재주%공첩음%림군
异氟醚%二异丙酚%高血压%心肌损伤%七氟醚
異氟醚%二異丙酚%高血壓%心肌損傷%七氟醚
이불미%이이병분%고혈압%심기손상%칠불미
Isoflurane%Propofol%Hypertension%Myocardial injury%Sevoflurane
目的 比较不同麻醉下老年高血压患者围术期心肌损伤的程度,为老年高血压患者选择适宜的麻醉方法.方法 择期行胸外科手术的老年高血压患者36例,年龄64岁,ASA Ⅱ或Ⅲ级,高血压Ⅱ级,高血压危险程度为中、高危险组,随机分为七氟醚组(S组)、异氟醚组(Ⅰ组)和异丙酚组(P组),每组12例.插管成功后至术毕,S组和I组呼气末吸入麻醉药浓度分别为1.7%、1.2%;P组静脉靶控输注异丙酚,血浆靶浓度2～3μg/ml.分别于麻醉前、气管插管后、手术探查后、拔除气管导管后即刻记录心电图ST段水平.于麻醉前、手术开始1 h、术毕、术后3、6、12、24 h抽取上肢静脉血,采用ELISA法测定血浆心肌肌酸激酶同工酶(CK-MB)活性和心肌肌钙蛋白I(cTnI)、白细胞介素-6(IL-6)、C反应蛋白(CRP)、可溶性细胞间粘附分子-1(sICAM-1)的浓度.结果 拔除气管导管后即刻P组ST段水平明显低于S组和I组(P<0.05);与麻醉前比较,手术开始至术毕24 h各组血浆CK-MB活性、cTnI、IL-6、CRP和slCAM-1浓度明显升高(P<0.05);S组和I组术后24 h血浆cTnI,IL-6、CRP和sICAM浓度明显低于P组(P<0.05).结论 采用七氟醚或异氟醚复合麻醉时较采用异丙酚复合麻醉时老年高血压患者心肌损伤程度轻,围术期的炎性反应减轻;老年高血压患者宜采用吸人麻醉.
目的 比較不同痳醉下老年高血壓患者圍術期心肌損傷的程度,為老年高血壓患者選擇適宜的痳醉方法.方法 擇期行胸外科手術的老年高血壓患者36例,年齡64歲,ASA Ⅱ或Ⅲ級,高血壓Ⅱ級,高血壓危險程度為中、高危險組,隨機分為七氟醚組(S組)、異氟醚組(Ⅰ組)和異丙酚組(P組),每組12例.插管成功後至術畢,S組和I組呼氣末吸入痳醉藥濃度分彆為1.7%、1.2%;P組靜脈靶控輸註異丙酚,血漿靶濃度2～3μg/ml.分彆于痳醉前、氣管插管後、手術探查後、拔除氣管導管後即刻記錄心電圖ST段水平.于痳醉前、手術開始1 h、術畢、術後3、6、12、24 h抽取上肢靜脈血,採用ELISA法測定血漿心肌肌痠激酶同工酶(CK-MB)活性和心肌肌鈣蛋白I(cTnI)、白細胞介素-6(IL-6)、C反應蛋白(CRP)、可溶性細胞間粘附分子-1(sICAM-1)的濃度.結果 拔除氣管導管後即刻P組ST段水平明顯低于S組和I組(P<0.05);與痳醉前比較,手術開始至術畢24 h各組血漿CK-MB活性、cTnI、IL-6、CRP和slCAM-1濃度明顯升高(P<0.05);S組和I組術後24 h血漿cTnI,IL-6、CRP和sICAM濃度明顯低于P組(P<0.05).結論 採用七氟醚或異氟醚複閤痳醉時較採用異丙酚複閤痳醉時老年高血壓患者心肌損傷程度輕,圍術期的炎性反應減輕;老年高血壓患者宜採用吸人痳醉.
목적 비교불동마취하노년고혈압환자위술기심기손상적정도,위노년고혈압환자선택괄의적마취방법.방법 택기행흉외과수술적노년고혈압환자36례,년령64세,ASA Ⅱ혹Ⅲ급,고혈압Ⅱ급,고혈압위험정도위중、고위험조,수궤분위칠불미조(S조)、이불미조(Ⅰ조)화이병분조(P조),매조12례.삽관성공후지술필,S조화I조호기말흡입마취약농도분별위1.7%、1.2%;P조정맥파공수주이병분,혈장파농도2～3μg/ml.분별우마취전、기관삽관후、수술탐사후、발제기관도관후즉각기록심전도ST단수평.우마취전、수술개시1 h、술필、술후3、6、12、24 h추취상지정맥혈,채용ELISA법측정혈장심기기산격매동공매(CK-MB)활성화심기기개단백I(cTnI)、백세포개소-6(IL-6)、C반응단백(CRP)、가용성세포간점부분자-1(sICAM-1)적농도.결과 발제기관도관후즉각P조ST단수평명현저우S조화I조(P<0.05);여마취전비교,수술개시지술필24 h각조혈장CK-MB활성、cTnI、IL-6、CRP화slCAM-1농도명현승고(P<0.05);S조화I조술후24 h혈장cTnI,IL-6、CRP화sICAM농도명현저우P조(P<0.05).결론 채용칠불미혹이불미복합마취시교채용이병분복합마취시노년고혈압환자심기손상정도경,위술기적염성반응감경;노년고혈압환자의채용흡인마취.
Objective To compare the effects of sevoflurane and isoflurane on perioperative myocardial injury in elderly hypertensive patients. Methods Thirty-six patients with hypertension of Ⅱ degree aged>64 yr undergoing elective chest surgery were randomly divided into three groups of 12 patients each: group Ⅱ sevoflurane (Sevo); group Ⅱ isoflurane (Iso) and group Ⅲ propofol (Pro). The patients were premedicated with intramuscular midazolam 5 mg and iv scopolamine 0.3 mg. Anesthesia was induced with TCI of sufentanil (target Cp=0.5 ng/ml) and iv midazolam 0.025-0.050 mg/kg. Tracheal intubation was facilitated with pipecuronium as soon as the patients lost consciousness. The patients were mechanically ventilated. PaCO2 was maintained at 30-40 mm Hg. Anesthesia was maintained with 1.7% sevoflurane, or 1.2% isoflurane or propofol TCI (target Cp =2-3 μg/ml). ECG, HR, BP, CVP, SpO2, end-tidal PCO2 and BIS were continuously monitored during operation. BIS was maintained at 40-60. The changes in ST segment were recorded before anesthesia, after intubation and surgical exploration and immediately after extubation. Myocardial ischemia was defined as ST segment depression ≥0.1 mV for more than 1 min. Blood samples were obtained from peripheral vein of upper limb, before anesthesia (T0), 1 h after skin incision (T1), at the end of operation (T2) and 3, 6, 12, 24 h after operation (T3-6) for determination of plasma CK-MB activity and plasma concentrations of cTnI, IL-6, CRP and slCAM-1. Results The ST segment depression was significantly deeper after extubation in group Pro than in group Sevo and Iso. The plasma CK-MB activity and cancentratioas of cTnl, IL-6, CRP and slCAM-1 were significantly increased after operation in all 3 groups. The plasma levels of cTnI, IL-6, CRP and slCAM-I were significantly higher in group Pro than in group Sevo and Iso. Conclusion Myocardial injury is less severe during the first 24 h after chest operation performed under sevoflurane or isoflurane anesthesia than under propofol anesthesia.
