七氟烷与丙泊酚诱导麻醉对老年人心肌收缩功能的影响

Difference of Anesthesia Induction of Sevoflurane and Propofol on Myocardial Contractility in Elderly Patients

目的:观察老年人丙泊酚或七氟烷诱导麻醉期间心肌收缩功能的变化,寻求合理处理,减少围麻醉期循环系统并发症。方法:择期行腹部手术患者45例,ASAII级,年龄>65岁,按麻醉诱导方案不同,随机分为3组:Ⅰ、Ⅱ组(观察组)分别吸入5%、7%七氟烷诱导,Ⅲ组(对照组)静脉注射丙泊酚1.0-1.5mg/kg诱导。采用阻抗法监测心率(HR)、心输出量(CO)、每搏输出量(SV)、速度指数(VI)、心肌加速度指数(ACI)、左心室射血时间(LVET)、射血前期(PEP)和收缩-时间比率(STR)的变化。结果:STR在各时点和组间存在显著的交互效应,与观察组比较Ⅲ组静脉注射后3minPEP延长、LVET缩短、STR增加。SV、CO、ACI、VI、PEP和STR各时点间比较差异有统计学意义。与诱导前比较:HR降低出现早且持续诱导期全程;PEP延长、STR增加早于CO、ACI和VI的降低;在置入喉罩期间除LVET外,各参数与诱导前比较差异均有统计学意义,且持续至置入喉罩后3min。结论:1.0-1.5mg/kg丙泊酚静脉诱导对老年人心肌收缩功能的抑制强于5%、7%七氟烷吸入诱导麻醉。

Objective： To investigate the difference of anesthesia induction of sevoflurane and propofol on myocardial contractility in elderly patients. Methods： Forty-five patients aged over 65 years （ASA Ⅱ）were divided into three groups： patients with anesthesia induction of 5% sevoflurane （group Ⅰ）, patients with anesthesia induction of 7% sevoflurane （group Ⅱ）and patients with 1.0-1.5 mg/kg propofol intravenously （group Ⅲ）. The heart rate （HR）, cardiac output（CO）, stroke volume （SV）,velocity index （VI）,acceleration index （ACI）,lefl ventricular ejection time （LVET）,pre-ejection period （PEP）and systolic time ratio （STR） were recorded using BioZ ICG Monitor. Results： There was a significant reciprocation effect on STR between time points and groups. The value of PEP was prolonged with shorten of STR and LVET after 3min injection in group III. The values of SV, CO, ACI, VI, PEP and STR were significantly changed at each time point. Heart rate was decreased at the beginning of the induction and lasted the whole procedure. The prolongation of PEP and the increase of STR were appeared earlier than the decrease of CO,ACI and VI. Compared with baseline values, all of the parameters, except LVET,were statistically changed during the insertion of LMA-Proseal^TM and lasted until 3 min after intuhation. Conclusion： The 5% or 7% sevoflurane may he preferable to propofol （ 1.0-1.5 mg/kg） for anesthesia induction in elderly patients with respect to less effect on the myocardial contractility.