异氟烷吸入在大动物心脏手术实验中的应用效果评价

Effect evaluation of isoflurane inhalation in large animal cardiac surgery

目的比较大动物心脏手术实验中氯胺酮肌注和异氟烷吸入全身麻醉诱导的优劣,探索更适合大动物心脏手术的围术期麻醉管理策略,以提高实验质量、促进临床转化。方法选取体外循环下主动脉瓣置换术的小尾寒羊36只,随机均分为两组。分别给予肌肉注射8 mg/kg氯胺酮诱导和2%异氟烷面罩吸入诱导,合理追加剂量直至气管插管成功。术中麻醉维持均采用一致的静吸复合麻醉方案。收集插管期间的心率、血压指标,记录麻醉诱导时间、手术时长、体外循环时长、体外循环前及结束后的血气指标、麻醉药物总用量和动物死亡数量等。结果相较于氯胺酮组,异氟烷组的麻醉诱导时间明显缩短,差异有统计学意义(t=4.842,P<0.01);与气管插管前的心率相比,异氟烷组插管即刻增加的更少,差异有统计学意义(t=3.904,P<0.01),且插管后3 min恢复的更快,差异有统计学意义(t=2.794,P<0.01);与气管插管前的血压相比,异氟烷组插管即刻变化更大,具有统计学差异(t=4.858,P<0.01),插管后3 min降低更快,差异有统计学意义(t=2.996,P<0.01)。两组术中麻醉药物总用量、手术时长、体外循环时长、气管导管拔除所需时间和动物死亡数量差异无统计学意义(P>0.05)。结论异氟烷吸入麻醉诱导时间短、血流动力学稳定,创伤小、动物依从性高,更安全有效,可提高大动物体外循环下心脏手术实验质量。

Objective To compare the advantages and disadvantages of intramuscular ketamine injection and isoflurane inhalation anesthesia induction in large animal cardiac surgery,and to explore the suitable perioperative anesthesia management strategies for large animal cardiac surgery,so as to improve experimental quality and promote clinical transformation.Methods 36 healthy adult male Small-Tail Han sheep subjected to aortic valve replacement under cardiopulmonary bypass were randomly divided into two groups(18 in each group).Intramuscular injection of 8 mg/kg ketamine and inhalation induction of 2%isoflurane mask were given,and the appropriate additional dose was applied until tracheal intubation being finished.The two groups were administered the same intravenous-inhalation combined anesthesia strategy for maintenance of anesthesia.Heart rate and blood pressure indexes during intubation were collected.Anesthesia induction time,operation duration,cardiopulmonary bypass duration,blood gas before and after cardiopulmonary bypass,anesthetic consumption and animal mortality were recorded.Results Compared with ketamine group,the induction time of isoflurane group was significantly shortened,and the difference was statistically significant(t=4.842,P<0.01).Compared with the heart rate before endotracheal intubation,the immediate increase of intubation in the isoflurane group was less,and the difference was statistically significant(t=3.904,P<0.01),and the recovery was faster at 3 minutes post-intubation,and the difference was statistically significant(t=2.794,P<0.01).Compared with the blood pressure before endotracheal intubation,the immediate change of intubation was greater in the isoflurane group,showing a statistically significant difference(t=4.858,P<0.01),and the decrease was faster at 3 minutes post-intubation,showing a statistically significant difference(t=2.996,P<0.01).There was no statistically significant difference of total anesthetic consumption,operation duration,cardiopulmonary bypass duration,the time for extubation and the mortality between the two groups(P>0.05).Conclusion There were shorter induction time,more stable hemodynamics,less trauma,better animal compliance,more safety and efficacy in the isoflurane inhalation anesthesia induction,which can improve the quality of cardiac surgery on cardiopulmonary bypass in large animals.