七氟醚静脉-吸入复合麻醉对合并冠心病的老年腹腔镜手术患者麻醉质量心功能和心血管事件的影响

Effects of sevoflurane intravenous-inhalation combined anesthesia on anesthesia quality, cardiac function and cardiovascular events of elderly patients with coronary heart disease undergoing laparoscopic surgery

目的探究七氟醚静脉-吸入复合麻醉对合并冠心病的老年腹腔镜手术患者麻醉质量、心功能和心血管事件的影响。方法回顾性分析浙江省台州医院2020年7月至2023年8月收治的行腹腔镜手术的冠心病患者临床资料,从行丙泊酚麻醉的患者中随机抽取40例纳入对照组,从行七氟醚静脉-吸入复合麻醉的患者中随机抽取40例纳入观察组。比较2组患者麻醉质量(麻醉时间、麻醉满意度、清醒时间、定向恢复时间)差异;记录不同时间点[术前(T0)、手术开始时(T1)、手术进行15 min(T2)、术后(T3)]的生命体征[心率、收缩压(SBP)、舒张压(DBP)];比较T0、T3时的心功能[心排量(CO)、左室射血分数(LVEF)、N末端脑钠肽前体(NT-proBNP)]、心肌酶水平[天冬氨酸转氨酶(AST)、乳酸脱氢酶(LDH)、肌酸激酶同工酶(CK-MB)]、氧化应激[血清去甲肾上腺素(NE)、皮质醇(Cor)、促肾上腺皮质激素(ACTH)]水平;比较2组患者不良心血管事件发生情况。结果观察组满意度评分均高于对照组(P<0.05),观察组麻醉时间、清醒时间、定向恢复时间均低于对照组(P<0.05);在T0、T3时,2组患者心率、SBP、DBP水平差异无统计学意义(P>0.05),T1、T2时,观察组心率、SBP、DBP水平均高于对照组(P<0.05);T3时,2组患者CO、LVEF水平均较T0时降低,且观察组高于对照组(P<0.05),2组患者NT-proBNP、AST、LDH、CK-MB、NE、Cor、ACTH水平均较T0时升高,且观察组低于对照组(P<0.05);观察组心血管不良事件发生情况低于对照组(P<0.05)。结论七氟醚静脉-吸入复合麻醉在合并冠心病的老年腹腔镜手术患者中具有较高的麻醉质量,能减少对心功能的损伤,且不会增加不良心血管事件的发生风险。

Objective To explore the influence of sevoflurane intravenous-inhalation combined anesthesia on anesthesia quality,cardiac function and cardiovascular events among elderly patients with coronary heart dis-ease undergoing laparoscopic surgery.Methods A retrospective analysis was conducted on the clinical data of patients with coronary heart disease who received laparoscopic surgery admitted to Taizhou Hospital of Zhejiang Province from July 2020 to August 2023.Forty patients who adopted propofol anesthesia were randomly selected and included in the control group,and 40 patients who received sevoflurane intravenous-inhalation combined anesthesia were randomly included in observation group.The anesthesia quality(anesthesia time,anesthesia satis-faction,awakening time,orientation recovery time)of the two groups were compared.The vital signs[heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP)]at different time points[before surgery(T0),at the beginning of surgery(T1),15 min into surgery(T2),after surgery(T3)]were recorded.The caediac function[cardiac output(CO),left ventricular ejection fraction(LVEF),N-terminal pro-brain natriuretic peptide(NT-proB-NP)],myocardial enzymes[aspartate aminotransferase(AST),lactate dehydrogenase[LDH,creatine kinase isoen-zyme(CK-MB)]and oxidative stress[serum norepinephrine(NE),cortisol(Cor),adrenocorticotropic hormone(ACTH)]levels at T0 and T3 were compared.Results The satisfaction score of observation group were higher than those of the control group(P<0.05),and the anesthesia time,awakening time and orientation recovery time were of the observation group were all lower than those of the control group(P<0.05).At T0 and T3,there was no significant differences in HR,SBP and DBP levels between the two groups(P>0.05).However,at T1 and T2,the HR, SBP and DBP levels of the observation group were higher than those of the control group (P<0.05). At T3, the CO and LVEF levels of both groups were lower than those at T0, and the observation group was higher the control group (P<0.05). The NT-proBNP, AST, LDH, CK-MB, NE, Cor and ACTH levels of both groups were higher than those at T0, and the observation group were lower than the control group (P<0.05). The incidence r of adverse car-diovascular events in the observation group was lower than that in the control group (P>0.05). Conclusion The sevoflurane intravenous-inhalation combined anesthesia has high anesthesia quality in elderly patients with coro-nary heart disease undergoing laparoscopic surgery, which can reduce the damage to cardiac function and does not increase the risk of adverse cardiovascular events.