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| 术中持续泵注艾司洛尔对老年腹腔镜胃肠癌根治术患者的心肌保护作用 |
| Cardioprotection of intraoperative continuous infusion of esmolol in elderly patients undergoing laparoscopic surgery |
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| DOI： |
| 中文关键词: 艾司洛尔 老年患者 心血管功能 心肌保护 |
| 英文关键词: Esmolol Elderly patients Cardiovascular function Myocardial protection |
| 基金项目:江西省卫生厅科技计划项目(20131050) |
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| 中文摘要: |
| 目的 研究术中持续泵注艾司洛尔对老年腹腔镜胃肠癌根治术患者的心肌保护作用。方法 选择择期行腹腔镜胃肠癌根治术患者60例,男32例,女28例,年龄65～80岁,体重40～80 kg,ASA Ⅰ或Ⅱ级,随机分为两组:艾司洛尔组(E组)和对照组(NS组)，每组30例。E组插管前3 min静脉注射艾司洛尔0.3 mg/kg,并于术中持续泵注艾司洛尔50 μg·kg-1·min-1至气管拔管；NS组以生理盐水替代艾司洛尔。记录麻醉诱导前(T0)、气管插管后即刻(T1)、气腹建立即刻(T2)、手术结束时(T3)、拔管即刻(T4)及拔管后30 min(T5)的MAP、HR、SpO2、PETCO2、BIS,并计算RPP。检测麻醉诱导前、术后6 h、术后30 h血清肌钙蛋白I(cTnI)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)和乳酸脱氢酶(LDH)的浓度。记录围术期和术后3个月相关不良事件发生情况。结果 T1、T2、T4时E组的HR明显慢于NS组，MAP、RPP明显低于NS组(P＜0.05)。两组患者血清cTnI、CK、CK MB、LDH各时点浓度差异无统计学意义。围术期无一例发生严重低血压和心动过缓。术后随访3个月,两组均无一例心脑血管意外等不良事件发生。结论 术中持续泵注艾司洛尔50 μg·kg-1·min-1对术前无明显心肌损伤的老年腹腔镜手术患者心肌损伤标志物血清浓度影响不大,但可有效减轻刺激引起的心血管反应,稳定血流动力学,降低心肌耗氧量,保护心肌。 |
| 英文摘要: |
| Objective To investigate the myocardial protection of intraoperative continuous infusion of esmolol in elderly patients undergoing laparoscopic surgery. Methods Sixty patients, thirty-two males and twenty-eight females, aged 65-80 years, weighing 40-80 kg, ASA physical status Ⅰ or Ⅱ, undergoing selective general anesthesia laparoscopic resection of gastrointestinal cancer were randomly divided into 2 groups (n=30): esmolol group (group E) and control group (group NS). Group E was administered esmolol 0.3 mg/kg 3 minutes before intubation, then with a continuously infusing rate of 50 μg·kg-1·min-1 until extubation. Group NS was administered saline instead. MAP, HR, SpO2, PETCO2, BIS and RPP were recorded before intubation (T0), intubation (T1), pneumoperitoneum (T2), the end of surgery (T3), extubation (T4) and 30 minutes after extubation (T5). The serum levels of cTnI, CK, CK-MB and LDH were measured before anesthesia and 6, 30 hours after surgery. Adverse cardiovascular event happened during perioperation and 3 months following up was recorded. Results HR, MAP, RPP at T1, T2, T4 in group E were obviously lower compared with group NS (P＜0.05). There were no significant differences in the serum levels of cTnI, CK, CK-MB and LDH between two groups at different time points. No major adverse cardiovascular event happened in two groups during perioperation and 3 months following up. Conclusion Intraoperative continuous infusion of esmolol 50 μg·kg-1·min-1 can not significantly influence the serum level of myocardial injury marker in the elderly patients without myocardial damage undergoing laparoscopic resection of gastrointestinal cancer. Howerver, it can effectively reduce the cardiovascular response caused by stimulation, decrease myocardial oxygen consumption, protect myocardial. |
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