地氟烷和异氟烷对风心病患者循环功能影响的比较

Comparison between effects of desflurane and isoflurane on the circulatory functions in patients with rheumatic heart disease

目的：观察和比较地氟烷和异氟烷对风心病患者循环功能的影响。方法：２０例风湿性病心脏瓣膜置换患者随机均分成两组，每例在麻醉诱导前局麻下作桡动脉穿刺和右颈内静脉穿刺放置漂浮导管各测循环功能指标、用咪达唑仑 ０， １５ ｍｇ／ｋｇ、芬太尼１０ μｇ／ｋｇ、维库溴铵８ ｍｇ静脉注射麻醉诱导，其后两组分别吸入１．０ ＭＡＣ地氟烷和１．０ ＭＡＣ异氟烷，利用ＨＰ多功能监护仪观察两组在吸入地氟烷或异氟烷前后循环功能的改变。结论：两组在吸入 １． ０ ＭＡＣ地氟烷或 １． ０ ＭＡＣ异氟烷后体循环压力（ＡＢＰ）、体血管阻力（ＳＶＲ）、左心功指数（ＬＶＷＩ）均显著性降低，两组之间这３项功能指标降低幅度没有显著性差异。结论：低浓度地氟烷可以象异氟烷那样安全地应用于风心病患者心脏瓣膜置换手术麻醉。

Objective:To investigate and compare effects of desflurane and isoflurane on the circulatory functions in patients with rheumatic heart disease (RHD). Methods: Twenty patients with RHD were divided into 2 groups randomly (n = 10). Under local anesthesia, each patient received a radial artery puncture and a right jugular vein puncture to be catheterized with a pulmonary catheter for measurement of the circulatory functions before induction, then was induced with midazolam 0. 15 mg/kg, fentanyl 10 μg/kg and vecuronium 8 mg intravenously. After induction, each patient inhalationly received 1. 0 MAC desflurane or 1. 0 MAC isoflurane and HP multifunctional monitoring instrument was used to study the changes of the circulatory functions 30 minutes after inhalation. Results: After inhalation of 1. 0 MAC desflurane or 1. 0 MAC isoflurane, systemic pressure, systemic cardiovascular resistance and left cardiac work all decreased significantly, and there were no significant differences between the amplitudes of decreases of the 3 circulatory functions index in 2 groups. Conclusion: Low concentration of desflurane can be used as safely as low concentration of isoflurane in general anesthesia for patients undergoing cardiac valve replacement.