小剂量艾司洛尔对老年人围术期心肌肌钙蛋白Ⅰ的影响

Effect of low dose esmolol on cardiac troponin I during perioperative period in geriatric patients

目的观察围术期小剂量艾司洛尔持续静脉滴注对老年患者心肌肌钙蛋白I(cTnI)表达的影响。方法择期行胃、肠道手术的老年患者120例,年龄60～75岁,随机分为艾司洛尔组和对照组,每组60例。艾司洛尔组从麻醉诱导前5min开始持续静脉滴注艾司洛尔20μg.kg-1.min-1,对照组则以相同的速度静脉滴注0.9%氯化钠溶液。记录患者入手术室后、麻醉诱导前、诱导后3min、气管插管后即刻、气管插管后3min、切皮前、切皮后3min、探查腹腔前、探查腹腔后、手术结束时(缝完最后一针)、气管插管拔管前、气管插管拔管后3min各时间点的心率和平均动脉压(MAP)。检测患者在手术开始前、手术结束时、术后24h的血清cTnI水平。结果对照组气管插管后即刻、切皮后3min、探查腹腔后的心率均分别较该操作前显著加快(P值均<0.05),MAP均分别较该操作前显著升高(P值均<0.05)。而艾司洛尔组仅气管插管后和探查腹腔后即刻的MAP较该操作前显著升高(P值均<0.05),其余时间点心率和MAP的差异均无统计学意义(P值均>0.05)。两组各时间点血清cTnI水平的差异均无统计学意义(P值均>0.05)。结论老年患者术中持续静脉滴注艾司洛尔20μg.kg-1.min-1有助于维持血流动力学的稳定,减轻气管插管等手术刺激时的心血管反应,但对血清cTnI水平无明显影响。

Objective To observe the effect of low dose esmolol on the serum concentretion of cardiac troponin I（cTnI） during the perioperative period in elderly patients.Methods Totally 120 patients,aged from 60 to 75 years,scheduled for gastrointestinal operation were randomly divided into esmolol group and control group（n=60）.Esmolol（20 μg·kg^-1·min^-1） or 0.9% sodium chloride solution was continuously infused from 5 mins before induction.Heart rate（HR） and mean arterial pressure（MAP） were recorded at the points as follows：baseline,before induction,3 mins after induction,immediately after intubation,3 mins after intubation,before incision,and 3 mins after incision,before abdominal exploration,after abdominal exploration,at the end of surgery,before extubation,3 mins after extubation.The serum level of cTnI was examined before surgery,at the end of surgery and 24 h after surgery.Results In control group,HR and MAP were significantly increased immediately after intubation,3 mins after incision,and after abdominal exploration as compared with before these procedures（all P0.05）.In esmolol group,MAP were significantly elevated immediately after intubation and abdominal exploration（all P0.05）,and there were no significant differences in HR and MAP at the other time points（all P0.05）.There was no significant difference of cTnI level between two groups at either time point（all P0.05）.Conclusion For geriatric patients,continuous infusion of low dose esmolol（20 μg·kg^-1·min^-1） during the surgery can keep hemodynamic parameters stable and reduce cardiovascular responses to intubation,but it has no significant effect on the serum concentretion of cTnI.（Shanghai Med J,2012,35：841-843）