不同全身麻醉剂对老年冠心病患者实施非心脏手术后不良事件的影响

Effect of adverse events from different general anesthetic in implementation of non-cardiac surgery for elderly patients with coronary heart disease

目的探讨和比较不同全身麻醉剂对老年冠心病患者实施非心脏手术后不良事件的影响。方法选取我院收治的96例老年冠心病实施非心脏手术患者作为临床研究对象,并将其随机分为七氟醚组和咪达唑仑组,每组48例。七氟醚组手术患者采用七氟醚+芬太尼+维库溴铵的麻醉方案,咪达唑仑组手术患者采用咪达唑仑+芬太尼+维库溴铵的麻醉方案,并分别对两组患者的常规不良反应事件发生情况和心脏不良反应事件发生情况进行比较和分析。结果与咪达唑仑组患者相比,七氟醚组患者发生恶心、呕吐等常规不良反应事件的比率均显著升高,发生心率失常、心绞痛等心脏不良事件的比率均显著降低,差别均具有统计学意义(P<0.05)。结论在老年冠心病患者实施非心脏手术的过程中,采用七氟醚麻醉可获得较好的心肌保护作用,且心脏不良反应事件的发生率相对较低,而发生恶心和呕吐等常规不良反应的发生率则相对较高;采用咪达唑仑麻醉则容易诱发多种心脏不良反应事件的发生。

Objective To explore and compare the effect of adverse events from different general anesthetic in the implementation of the non-cardiac surgery for elderly patients with coronary heart disease. Methods Selected 96 elderly coronary heart disease patients implementation of non-cardiac surgery in our hospital. All the patients were divided into sevoflurane group and midazolam group randomly. There were 48 cases in each group. The patients in sevoflurane group used sevoflurane ＋ fentanyl ＋ vecuronium anesthesia program. The patients in midazolam group used midazolam ＋ fentanyl ＋ vecuronium anesthesia program. The conventional adverse events occurrence and incidence of cardiac adverse events of the patients in two groups were compared and analyzed. Results Compared with midazolam group, the patients in sevoflurane group, the rate of conventional adverse events such as nausea and vomiting occurred were increased significantly, the rate of cardiac adverse events such as cardiac arrhythmias and angina were decreased significantly, there were significant difference （ P 〈 0. 05）. Conclusions For the elderly coronary heart disease, the use of sevoflurane anesthesia could be obtained better myocardial protection in the process of implementation of the non-cardiac surgery. Using of sevoflurane anesthesia, the incidence of cardiac adverse events was relatively low. The incidence of the conventional adverse reactions such as nausea and vomiting was relatively high. Using of midazolam anesthesia, it was likely to cause a variety of cardiac adverse events occurred.