摘要
目的探讨3种不同全身麻醉剂对老年冠心病患者实施非心脏手术后不良事件发生率及死亡率的影响,为优化麻醉策略奠定基础。方法择期行非心脏手术的老年冠心病患者65例,ASAⅢ级或Ⅳ级,年龄60～80岁,随机分为七氟醚组(S组,n=20)、丙泊酚组(P组,n=25)和咪达唑仑组(M组,n=20),分别以七氟醚-芬太尼-维库溴铵、丙泊酚-芬太尼-维库溴铵和咪达唑仑-芬太尼-维库溴铵实施麻醉诱导及维持。术中常规监测患者生命体征,术后3d內观察随访恶心、呕吐、高血压、低血压、心律失常、心绞痛、急性心肌梗死、急性心衰的发生情况。结果 S组患者术后2h内恶心、呕吐的发生率明显高于P组与M组,差异有统计学意义(P<0.05),3组间术后3d内心律失常、心绞痛的发生率差异有统计学意义(P<0.05),M组患者出院后30d内心绞痛的发生率明显高于S组(P<0.05),3组间其他不良事件的发生率及死亡率的差异无统计学意义。结论老年冠心病患者行非心脏手术时,咪达唑仑容易诱发术后心脏相关不良事件的发生,七氟醚具有一定的心肌保护作用,心脏相关不良事件的发生率较低,但术后早期恶心呕吐发生率较高。
Objective To compare the incidence and mortality among different general anesthetic agents on postoperative adverse events in elderly patients with coronary artery disease undergoing non-cardiac surgery.Methods Sixty-five patients,ASA classⅢorⅣ,aged 60to 80years old,scheduled for selective non-cardiac surgical procedures under general anesthesia were randomized into 3groups：20cases in sevoflurane anesthesia group（S group）,25cases in propofol anesthesia group（P group）and 20cases in midazolam anesthesia group（M group）.As for induction and maintenance of anesthesia,patients in group S received inhalation anesthesia with sevoflurane-fentanyl-vecuronium,patients in group P received intravenous anesthesia with propofol-fentanyl-vecuronium,and those in group M received anesthesia with midazolam-fentanyl-vecuronium.Patient＇s basal vital sign were monitored in routine method during the operation,Patients were followed up in the 3days after surgery and general anesthetic adverse events were recored including PONV,hypertension,hypotension,arrhythmia,angina,acute myocardial infarction and acute heart failure.Results The incidence of nausea and vomiting of group S in postoperative 2hours were significantly higher than group P and group M（P 0.05）,the incidence of arrhythmia and angina among 3groups within 3days after surgery was significantly different（P 0.05）,the incidence of angina of group M within 30days after discharge was significantly higher than group S（P〈0.05）.There were no statistically significant differences among 3groups in the incidence and mortality of other adverse events.Conclusion As for elderly patients with coronary artery disease undergoing non-cardiac surgery,midazolam can easily lead to the incidence of angina and arrhythmia within 3days after surgery and the incidence of angina within 30days after patient discharge.Sevoflurane exerts myocardial protection effect to a certain extent,the incidence of cardiac adverse events was lower in sevoflurane group,but easily lead to the occurrence of nausea and vomiting in postoperative 2hours.
出处
《新疆医科大学学报》
CAS
2010年第9期1128-1131,共4页
Journal of Xinjiang Medical University
关键词
老年
冠心病
七氟醚
丙泊酚
咪达唑仑
elderly
coronary artery disease
sevoflurane
propofol
midazolam
