不同浓度七氟醚对患者左心功能的影响

Effects of different concentrations of sevoflurane on left ventricular function

目的 评价不同浓度七氟醚对患者左心功能的影响.方法 全麻下择期手术患者40例,性别不限,年龄30～50岁,BMI 18～25 kg/m2,ASA分级Ⅰ级,采用随机数字表法,将其分为4组（n=10）,Ⅰ组、Ⅱ组、Ⅲ组和Ⅳ组麻醉诱导时呼气末七氟醚浓度分别为2％、3％、4％和5％.采用超声心动图监测心功能指标,分别于麻醉诱导前（T0,基础状态）、呼气末七氟醚浓度达到目标浓度后3min（T1）、5 min（T2）、8 min（T3）、10 min（T4）时记录左心室舒张末期内径、左心室收缩末期内径（LVESD）、左心室射血分数（LVEF）、左心室短轴缩短率、心输出量（CO）和心率（HR）.结果 LVEF、CO和HR均在正常范围;与T0时比较,Ⅱ组-Ⅳ组T2～4时LVEF、左心室短轴缩短率和CO降低,Ⅲ组和Ⅳ组T2～4时左心室收缩末期内径升高（P＜0.05）,各时点左心室舒张末期内径和HR比较差异无统计学意义,Ⅰ组上述指标比较差异无统计学意义（P＞0.05）.结论 吸入2％七氟醚对患者左心功能无明显影响,吸入3％～5％七氟醚对左心室收缩功能有轻度抑制作用,而对左心室舒张功能无明显影响.

Objective To evaluate the effects of different concentrations of sevoflurane on the left ventricular function of patients.Methods Forty patients of both sexes,aged 30-50 yr,with body mass index of 18-25 kg/m2,of American Society of Anesthesiologists physical status Ⅰ,were divided into Ⅰ,Ⅱ,Ⅲ,and Ⅳ groups （n =10 each） using a random number table.The end-tidal concentration of sevoflurane was set at 2%,3%,4% and 5% in Ⅰ,Ⅱ,Ⅲ and V groups,respectively.The parameters of left ventricular function were monitored using the ultrasonic cardiogram.Before induction of anesthesia （T0,baseline） and at 3,5,8 and 10 min after the end-tidal concentration of sevoflurane reached the target concentration （T1-4）,the left ventricular end-diastolic diameter,left ventricular end-systolic diameter,left ventricular ejection fraction （LVEF）,left ventricular fractional shortening,cardiac output （CO） and heart rate （HR） were recorded.Results The LVEF,CO and HR were within the normal range.Compared with those at T0,the LVEF,left ventricular fractional shortening and CO were significantly decreased at T2-4 in Ⅱ-Ⅳ groups,the left ventricular end-systolic diameter was increased at T2-4 in Ⅲ and Ⅳ groups （P〈0.05）,no significant change was found in the left ventricular end-diastolic diameter and HR at each time point in Ⅲ and Ⅳ groups,and no significant change was found in the parameters mentioned above in group Ⅰ （P〉0.05）.Conclusion Inhaling 2% sevoflurane produces no marked effect on the left ventricular function,3%-5% sevoflurane exerts inhibitory effect on the left ventricular systolic function,and has no effect on the left ventricular diastolic function of patients.