美托洛尔对缺血性心脏病患者麻醉期间氧耗的影响

摘要

Objective To evaluate the influence of metoprolol on oxygen metabolism during general anesthesia of ischemia heart disease patients. Methods Sixty patients with ischemia heart disease scheduled for abdominal surgery were randomly divided into three groups: control group ( I, saline, n = 20), low-dosed metoprolol group [ II, 1 μg/(kg·min) × 90 min, n = 20], middle-dosed metoprolol [group M, 2 μg/(kg·min) × 90 min, n = 20 ]. Under the midazolam-fentanyl-vecurunium-propofol anesthesia, the HR, MAP, cardiac index (CI, by NICO2), minute CO2 production (MVCO2), oxygen consumption (VO2) were recorded at 0(T0), 10(T1), 30 (T2), 60 (T3), 90 (T4) min after metoprolol or saline infused during anesthesia. Results No intergroup differences in HR, MAP, MVCO2 ,VO2 were found at To, T1 and T2. The HR was less in group II and group M than group I at T3 and T4. The CI, MVCO2 and VO2 were significantly increased at T3 and T4 than that at TO in group I, but not in group II and group Ⅲ. The CI, MVCO2 and VO2 were significantly greater in group I than that of group II and group Ⅲ at T3 and T4 (P < 0.01). Conclusions Low to middle dosed metoprolol significantly decreased the oxygen consumption of patient with ischemia heart disease during abdominal surgery.%目的:观察美托洛尔对缺血性心脏病患者全身麻醉期间氧代谢的影响.方法:60例有缺血性心脏病史择期行上腹部手术患者,随机分为对照组(组I,生理盐水,n=20)、低剂量美托洛尔[组Ⅱ,1μg/(kg·min)×90 min,n=20]、中剂量美托洛尔组[组Ⅲ,2μg/(kg·min)×90 min,n=20].采用咪唑安定-芬太尼-维库溴铵-丙泊酚麻醉.手术开始后输注美托洛尔或生理盐水,在开始用药时(T0)和用药后10 min(T1)、30 min(T2)、60 min(T3)、90 min(T4)测定心率(HR)、平均血压(MAP)、心指数(CI,NICO2法)、CO2分钟生成量(MVCO2),同步抽取桡动脉血和混合静脉血行血气分析,并计算氧耗量(VO2).结果:在T0、T1、T2时间点,组Ⅱ、组Ⅲ与组I比组间HR、MAP、CI、MCO2、VO2差异无显著性(P>0.05).在T3、T4时间点组I的CI、VO2、MVCO2显著上升,而组Ⅱ、组Ⅲ无明显增加,组间差异有显著性(P<0.01).结论:持续应用小剂量和中剂量美托洛尔可降低全身麻醉下缺血性心脏病患者腹部手术中氧耗,并改善血流动力学.