七氟醚与丙泊酚麻醉对老年冠心病非心脏手术患者血流动力学心肌保护及不良事件的影响

Effects of Sevoflurane Anesthesia and Propofol Anesthesia on Hemodynamics Myocardial Protection and Adverse Events in Elderly Patients with Coronary Heart Disease Undergoing Non-Cardiac Surgery

目的:探究七氟醚与丙泊酚麻醉对老年冠心病非心脏手术患者血流动力学、心肌保护及不良事件的影响。方法:选择2017年9月至2020年9月我院收治的132例老年冠心病患者作为研究对象,简单随机分组将其分为七氟醚组(n=66例)与丙泊酚组(n=66例),行非心脏手术时分别使用3%七氟醚持续吸入与3μg/mL丙泊酚持续输注进行麻醉。比较两组患者手术情况、心肌标志物、血流动力学参数、心脏不良事件及其他不良事件发生情况。结果:七氟醚组患者清醒时间、拔管时间及输液量显著少于丙泊酚组(P<0.05);术后即刻,七氟醚组心肌肌钙蛋白I(cTnI)水平显著低于丙泊酚组(P<0.05),术后12h及术后24h,七氟醚组cTnI及肌酸激酶同工酶(CK-MB)水平显著低于丙泊酚组(P<0.05);T1时,七氟醚组SBP水平显著高于丙泊酚组(P<0.05),T2时,七氟醚组心率(HR)水平显著低于丙泊酚组,收缩压(SBP)水平显著高于丙泊酚组(P<0.05),T3时,七氟醚组SBP水平显著高于丙泊酚组(P<0.05),T4时,七氟醚组HR水平显著低于丙泊酚组,SBP及舒张压(DBP)水平显著高于丙泊酚组(P<0.05),T5时,七氟醚组SBP及DBP水平显著高于丙泊酚组(P<0.05);七氟醚组心脏总不良反应的发生率为10.61%,显著低于对照组的28.79%;七氟醚组其他总不良反应的发生率为19.70%,显著高于对照组的6.06%(P<0.05)。结论:七氟醚麻醉在老年冠心病患者进行非心脏手术时有更稳定的血流动力学效应,麻醉与苏醒时间更短,对心肌有更好地保护作用,且输液量与心脏不良事件发生率更低,但易发生恶心呕吐等不良事件,适合有打针恐惧感、潜在气道困难与心脏风险的患者。

Objective:To explore the effects of sevoflurane anesthesia and propofol anesthesia on hemodynamics,myocardial protection and adverse events in elderly patients with coronary heart disease undergoing non-cardiac surgery.Methods:A total of 132 elderly patients with coronary heart disease admitted to the hospital between September 2017 and September 2020 were selected as the research subjects,and they were simply randomly divided into sevoflurane group(n=66)and propofol group(n=66),and respectively given continuous inhalation of 3%sevoflurane and continuous infusion of 3μg/ml propofol for anesthesia during non-cardiac surgery.The surgical status,myocardial markers,hemodynamic parameters and occurrence of cardiac adverse events and other adverse events were compared between the two groups.Results:The awake time,extubation time and transfusion volume of sevoflurane group were significantly shorter or less than those of propofol group(P<0.05).Immediate measure after surgery showed that the level of cardiac troponin I(cTnI)was significantly lower in sevoflurane group than that in propofol group(P<0.05).The levels of cTnI and creatine kinase-MB(CK-MB)in sevoflurane group at 12h and 24h after surgery were significantly lower than those in propofol group(P<0.05).At T1,the SBP of sevoflurane group was significantly higher compared to propofol group(P<0.05).At T2,the heart rate(HR)of sevoflurane group was significantly lower than that of propofol group while the systolic blood pressure(SBP)was significantly higher than that of propofol group(P<0.05).At T3,the SBP was significantly higher in sevoflurane group compared with that in propofol group(P<0.05).At T4,the HR of sevoflurane group was significantly lower while the SBP and diastolic blood pressure(DBP)were significantly higher compared to propofol group(P<0.05).At T5,the SBP and DBP in sevoflurane group were significantly higher than those in propofol group(P<0.05).The total incidence rate of adverse cardiac reactions was 10.61%in sevoflurane group,which was significantly lower than 28.79%in propofol group.The total incidence rate of other adverse reactions in sevoflurane group was significantly higher than that in propofol group(19.70%vs 6.06%)(P<0.05).Conclusion:Sevoflurane for anesthesia has a more stable hemodynamic effect and shorter anesthesia time and recovery time in elderly patients with coronary heart disease undergoing non-cardiac surgery,and it better protects the myocardium and has less transfusion volume and lower incidence of cardiac adverse events.But it is prone to adverse events such as nausea and vomiting,thus it is suitable for patients with fear of injections,potential airway difficulties and heart risks.