通过体外循环心脏手术实验比较两种全身麻醉方案的优劣

Comparison of two general anesthesia schemes in cardiac surgery under cardiopulmonary bypass:an experimental study

目的比较评价小尾寒羊等大动物实验中氯胺酮和丙泊酚进行全身麻醉的优劣,探索更适合大动物实验的围术期麻醉管理策略。方法选取雄性健康小尾寒羊36只,于2017年3月1日至12月1日在空军军医大学第一附属医院行二尖瓣反流模型构建手术。采用随机数字表法将实验室分为氯胺酮组和丙泊酚组,每组18只。氯胺酮组采用单纯肌内注射氯胺酮进行麻醉诱导,丙泊酚组采用丙泊酚复合芬太尼全凭静脉进行麻醉诱导。比较2组的一般资料、手术相关指标、血气及循环指标。结果丙泊酚组麻醉诱导时间明显短于氯胺酮组[(3.2±2.5)min比(19.5±5.4)min],差异有统计学意义(P<0.05)。2组手术时间、体外循环时间、术后气管导管拔除时间及麻醉维持阶段异氟醚吸入时间、丙泊酚用量、死亡率差异均无统计学意义(均P>0.05)。体外循环后丙泊酚组动脉血氧分压高于氯胺酮组,动脉血二氧化碳分压、呼气末二氧化碳分压低于氯胺酮组[(300±58)mm Hg(1 mm Hg=0.133 k Pa)比(210±52)mm Hg、(40±4)mm Hg比(45±4)mm Hg、(30±4)mm Hg比(35±4)mm Hg],差异均有统计学意义(均P<0.05)。气管插管前后丙泊酚组血流动力学更平稳。结论在小尾寒羊的麻醉诱导过程中,相比于氯胺酮,丙泊酚复合芬太尼麻醉诱导时间短、插管容易、血流动力学稳定,更加安全、有效。丙泊酚复合芬太尼的围术期麻醉方案更适合大动物体外循环心脏手术实验。

Objective To observe the effects of general anesthesia with ketamine and propofol on Small-tail Han sheep and to explore the optimal anesthesia management strategy for large animal experiments.Methods Thirty-six healthy male adult Small-tail Han sheep were prepared for mitral regurgitation operation in the First Affiliated Hospital of Air Force Medical University from March 1st to December 1st,2017.The sheep were randomly divided into ketamine group and propofol group,with 18 in each group.The ketamine group was induced by intramuscular injection of ketamine,while the propofol group was induced by intravenous injection of propofol and fentanyl.General data,operation related indexes,blood gas and circulation indexes were analyzed.Results Anesthesia induction time in the propofol group was significantly shorter than that in the ketamine group[(3.2±2.5)min vs(19.5±5.4)min](P<0.05).There were no significant differences in operation time,cardiopulmonary bypass time,tracheal tube extraction time,doses of isoflurane and propofol,and mortality rate between groups(all P>0.05).After cardiopulmonary bypass,arterial partial pressure of oxygen in the propofol group was significantly higher,arterial partial pressure of carbon dioxide and end-expiration partial pressure of carbon dioxide were significantly lower than those in the ketamine group[(300±58)mm Hg vs(210±52)mm Hg,(40±4)mm Hg vs(45±4)mm Hg,(30±4)mm Hg vs(35±4)mm Hg](all P<0.05).Hemodynamics in the propofol group was more stable during tracheal intubation.Conclusion Anesthesia induction with propofol and fentanyl is safe and effective in Small-tail Han sheep;it shows shorter induction,easier intubation,more stable hemodynamics and it is more suitable for cardiopulmonary bypass surgery in large animals than ketamine.