七氟烷和地氟烷对非体外循环冠脉搭桥患者血流动力学和应激反应的影响

摘要

目的 观察七氟烷和地氟烷吸入麻醉对非体外循环冠脉搭桥术(OPCABG)患者血流动力学和应激反应的影响.方法 选择接受全身麻醉下OPCABG患者60例,年龄51~74岁,BMI 20~30kg/m 2,ASA分级Ⅲ级,随机分为七氟烷组(S组,n=30)和地氟烷组(D组,n=30).两组常规静脉麻醉诱导后插入气管导管,S组患者调节七氟烷浓度为1~1.5 MAC;D组调节地氟烷浓度为1 ~1.5 MAC.在不同时间点:手术开始前(T 0)、吻合血管前(T1)、吻合血管后(T2)、手术结束时(T3)和术后24小时(T4)记录血流动力学指标,并抽取血液标本进行皮质醇、胰岛素、肌酸激酶同功酶(CK-MB)和C反应蛋白(CRP)水平的检测.结果 D组患者术中血压、心率与T 0相比显著增加,差异有统计学意义(P<0.05).两组患者皮质醇、胰岛素、CK-MB和CRP与T 0相比显著增加,差异有统计学意义(P<0.05),但D组增加更为明显;组间比较,与D组相比S组患者:平均动脉压和心率在T1和T2显著降低,皮质醇和CK-MB水平在T1~T4显著降低,差异有统计学意义(P<0.05),胰岛素和CRP水平差异无统计学意义(P>0.05).结论 七氟烷比地氟烷吸入麻醉在OPCABG患者能更好地控制血流动力学的变化和应激反应.%Objective To observe the effects of sevoflurane and desflurane inhalation anesthesia on hemodynamics and stress reaction in patients with off-pump coronary artery bypass grafting(OPCABG).Methods A total of 60 patients with OP-CABG undergoing general anesthesia,age 51~74 years,BMI 20 to 30kg/m 2,ASA grade Ⅲ grade,were randomly divided into sevoflurane group(S group,n=30)and desflurane group(D group,n=30).Two groups of patients were inserted into tracheal tube after routine intravenous anesthesia induction.The concentration of sevoflurane in group S was 1 to 1.5 MAC,and the concentration of desflurane in group D was 1 to 1.5 MAC.Hemodynamic index was recorded and blood samples were collected for cortisol,insu-lin,creatine kinase isoenzyme(CK-MB)and C reaction protein(CRP)were detection at different time points:before the start of sur-gery(T0),before vascular anastomosis(T1),after vascular anastomosis(T2),at the end of operation(T3)and 24 hours after opera-tion(T4).Results The blood pressure and heart rate in operation of the patients in the D group were significantly increased com-pared with the T0,and the difference was statistically significant(P<0.05).The level of cortisol,insulin,CK-MB and CRP of the patients in the two groups were significantly increased compared with the T0,and the difference was statistically significant(P<0.05),but the D group was more obvious;comparison between groups,compared with the D group,the mean arterial pressure and heart rate decreased significantly in the T1and T2,cortisol and CK-MB levels in T1~T4 were significantly decreased in the S group,the difference was statistically significant(P<0.05),and there was no statistically significant differences in insulin and CRP levels(P>0.05).Conclusion Compared with desflurane,sevoflurane inhaled anaesthesia can better control changes in he-modynamics and stress reaction in OPCABG patients.