七氟烷与丙泊酚麻醉对非体外循环冠状动脉搭桥手术患者术后转归的影响

Effects of sevoflurane and propofol anesthesia on postoperative outcomes in patients undergoing off-pump coronary artery bypass surgery

目的研究七氟烷和丙泊酚麻醉诱导和维持下,非体外循环冠状动脉搭桥手术患者术后心功能的变化及临床转归。方法 60例非体外循环冠状动脉搭桥择期手术患者,根据术前心功能分为Ⅰ组（心功能Ⅰ~Ⅱ级,30例）、Ⅱ组（心功能〉Ⅱ级,30例）。两组内又随机分为丙泊酚组（Ⅰp组,15例;Ⅱp组,15例）和七氟烷组（Ⅰs组,15例,Ⅱs组,15例）。分别于术前、术后第1天、术后第3天、术后第5天测血浆脑钠肽（BNP）和C反应蛋白（CRP）水平。术后随访患者呼吸机辅助治疗时间,重症监护室（ICU）治疗时间及手术至出院时间。结果丙泊酚组与七氟烷组,术后BNP含量差异无统计学意义。对术后CRP含量的影响,七氟烷组明显小于丙泊酚组（P〈0.05）。七氟烷组ICU治疗时间明显短于丙泊酚组（P〈0.05）。结论选择不同麻醉药物丙泊酚和七氟烷维持麻醉,对非体外循环冠状动脉搭桥患者术后心功能的影响无明显差异,但七氟烷维持麻醉在抑制术后机体炎性反应方面优于丙泊酚,并且可以缩短ICU治疗时间。

Objective This study is aimed to compare the change of postoperative cardiac function and clinical outcomes of the OPCABG patients under sevoflurane or propofol anesthesia. Methods According to preoperative cardiac function, 60 patients undergoing OPCABG were divided into two groups, group I（patients with cardiac function grade III, n=30） and group II（patients with cardiac function 〉grade II, n=30）. Each group were subdivided into the propofol group（Ip, n=15; IIp, n=15） and the sevoflurane group（Is, n=15; IIs, n=15）. Plasma levels of BNP and CRP were measured at the pre-operation, the first day（POD1）, the third day（POD 3） and the fifth day（POD 5） after surgery. The ventilation time, Intensive Care Unit（ICU） stay and the time between the operation to discharge stay were observed. Results There were no statistically differences between two different kinds of anesthetics, propofol and sevoflurane in postoperative BNP levels. The postoperative CRP levels in the sevoflurane group were obviously less than those in the propofol group（P〈0.05）. The ICU stay in the sevoflurane group was significantly less than that in the propofol group（P〈0.05）. Conclusion No significant difference on postoperative cardiac function of OPCABG patients between the propofol and the sevoflurane. However, for the sake of inhibiting body inflammatory reaction after surgery and the length of ICU stay, sevoflurane is better than propofol.