七氟醚吸入诱导在心脏手术病人的应用及其对呼吸循环功能的影响

Sevoflurane Inhalation Induction in Cardiac Patients and Its Effects on Respiration and Circulation

目的：研究七氟醚或七氟醚Ｎ２Ｏ吸入方法用于心脏瓣膜病人的麻醉诱导及对呼吸、循环功能的影响。方法：３４例择期心脏瓣膜手术病人分为两组，组１（ｎ＝１６）以七氟醚Ｏ２，组２（ｎ＝１８）先吸入Ｎ２Ｏ至ＥＴＮ２Ｏ５０％，再以七氟醚Ｎ２ＯＯ２诱导，采用旁气流监测及ＳｗａｎＧａｎｚ导管方法监测呼吸和循环功能。结果：组１诱导时间为３～４分钟，入睡时ＥＴＳｅｖｆ为２３％（约１１ＭＡＣ）；组２为５～６分钟，诱导后ＥＴＮ２Ｏ为５０％，ＥＴＳｅｖｆ为１６％，总ＭＡＣ为１３。诱导过程平稳，诱导后组１的ＶＴ、ＭＶ、ＲＲ、ＰＥＴＣＯ２及Ｖ１．０无显著变化，但组２的ＶＴ和ＭＶ明显下降，ＲＲ未见加速，两组的ＶＴ和ＭＶ有显著差异（Ｐ＜００１）。两组的ＭＡＰ、Ｃｌ、ＬＶＷＩ、ＬＶＳＷＩ及ＲＶＷＩ在诱导后降低（Ｐ＜００５），组１的ＭＰＡＰ、ＳＩ及ＲＶＷＩ也明显降低（Ｐ＜００５）。结论：心脏瓣膜手术病人采用七氟醚吸入，诱导过程平稳，对呼吸、循环轻微抑制。

Objective: To study the inhalation induction with sevoflurane or sevofluraneN2O in cardiac valve disease patients and its effects on respiration and circulation. Methods: 34 patients scheduled for cardiac valve procedure were divided into two groups. Group1(n=16) was induced with sevoflurane and group2(n=18) with sevofluraneN2O as the N2O end tidal concentration reaching 50%. The side stream spirometry and SwanGanz catheter technique were used to monitor the respiratory and circulatory function. Results:Patients lost their consciousness in group1 when the ETSevf reached 23% (approximately11MAC) and when the ETN2O reached 50%, ETSevf16% (about 13MAC) in group2. The times for induction were 3 to 4 and 5 to 6 minutes respectively. The courses of induction were smooth in both groups. There were no changes in VT,MV,RR,ETCO2 and V10in group1 after induction, but VT and MV decreased significantly without an increase in RR in group2. The VT and MV between two groups were significantly different (P<001). The hemodynamic parameters of MAP,CI,LVWI,LVSWI,RVWIand RVSWI decreased significantly (P<005) in the two groups, and SI and RVSWI also decreased in group1 (P<005) during induction. Conclusion: Sevoflurane inhaled anesthesia in patients with cardiac valve disease is smooth during the induction and has a little depression on respiration and circulation.