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| 全凭静脉麻醉与全程吸入麻醉对老年腹部手术患者心脏功能的影响 |
| Effects of all intravenous anesthesia versus total inhalation anesthesia on the cardiac function in elderly patients during intestinal surgery |
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| DOI：10.12089/jca.2019.02.008 |
| 中文关键词: 七氟醚 全凭静脉麻醉 收缩功能 舒张功能 经食管超声心动图 |
| 英文关键词: Sevoflurane Total intravenous anesthesia Systolic function Diastolic function Transesophageal echocardiography |
| 基金项目: |
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| 中文摘要: |
目的 观察全凭静脉麻醉与全程吸入麻醉对老年患者行腹部手术时心脏舒缩功能的影响。
方法 择期行开腹肠道手术的老年患者40例，男23例，女17例，年龄65~80岁，ASA Ⅱ或Ⅲ级，随机分为两组：全凭静脉麻醉组（P组）和全程吸入麻醉组（S组），每组20例。P组诱导后泵注丙泊酚和瑞芬太尼维持麻醉，S组诱导后吸入七氟醚维持麻醉，两组均于诱导后静脉泵注右美托咪定0.5~1.0 μg·kg-1·h-1。记录插管后即刻（T0）、切皮后10 min（T1）、手术结束时（T2）的左室射血分数（LVEF）、左室短轴缩短率（FS）、经二尖瓣舒张早期血流速度（E）峰值及其与舒张晚期血流速度（A）峰值及其的比值（E/A）和E峰减速时间（EDT）;记录术后不良反应发生情况。
结果 与T0时比较，T1时两组LVEF、FS、E峰值、E/A差异无统计学意义，T2时两组LVEF、FS差异无统计学意义;T2时S组E峰值、E/A明显升高，EDT明显缩短（P<0.05）。T2时S组E峰值、E/A均明显高于P组，EDT明显短于P组（P<0.05）。两组均有2例（10%）恶心呕吐。
结论 与全凭静脉麻醉比较，全程吸入七氟醚可以更好地保护心脏舒张功能。 |
| 英文摘要: |
Ojective To evaluate the effects of all intravenous anesthesia and total inhalation anesthesia on left ventricular systolic and diastolic function in elderly patients undergoing intestinal surgery.
Methods Forty elderly patients without any history or signs of cardiovascular disease, 23 males and 17 females, aged 65 - 80 years, ASA physical status Ⅱ or Ⅲ, were randomly allocated into two groups. Maintenance of anesthesia was achieved by propofol-remifentanil respectively (group P) or sevoflurane inhalation (group S). Transesophageal echocardiography was performed as a baseline after intubation. Left ventricular ejection fraction (LVEF), fractional shortening (FS), peak E, E/A, peak E deceleration time(EDT) were measured after anesthesia induction (T0), 10 min after incision (T1), end of surgery (T2), respectively.
Results Compared with T0, LVEF, FS, Peak E, E/A of both groups were similar at T1. There were no statistical differences in LVEF and FS between the two groups at T2. However, the value of peak E and E/A of group S at T2 were significantly increased than the baseline T0 and higher than that of group P (P < 0.05). Meanwhile, EDT at T2 in group S was shorter than that at T0 and significant shorter than in group P (P < 0.05). There were two PONV cases in each of the two groups.
Conclusion Sevoflurane had a favourable effect on diastolic function in the elderly patients. Furthermore, sevoflurane showed advantage in maintaining hemodynamic stability during the operative period. |
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