异丙酚与七氟醚复合麻醉对活体肝移植患者心肌损伤及心脏自主神经系统的影响

doi:10.3969/j.issn.1671-7171.2020.01.037

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (0 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要 【目的】 比较异丙酚与七氟醚复合麻醉对活体肝移植患者心肌损伤及心脏自主神经系统的影响效果。【方法】 本院收治的120例择期拟行活体肝移植术患者,按手术麻醉方法分为两组,各60例,其中观察组行七氟醚复合麻醉,对照组行异丙酚复合麻醉。比较两组各时点(包括手术开始1 h、门静脉阻断5 min、门静脉阻断1h、门静脉开放5 min、门静脉开放1 h、门静脉开放2 h、术毕)心率(HR)、右心房压(RAP)、平均动脉血压(MAP)、平均肺动脉压(MPAP)、心指数(CI)、肺动脉阻塞压(PAOP)、肺血管阻力指数(PVRI)、外周血管阻力指数(SVRI)变化,分析切皮前即刻、无肝期30 min、新肝期30 min、术毕及术后24 h、48 h、72 h时血清心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)变化。另统计手术开始1 h、阻断前1 h、阻断1 h、开放后1 h、开放后2 h、术毕1 h时心率变异性的NN间期标准差(SDNN)、NN间期平均值标准差(SDANN)、相邻NN间期差均方根(rMSSD)。【结果】 两组各时点HR、RAP、MAP、MPAP、CI、PAOP、PVRI、SVRI比较差异均无显著性(P＞0.05)。两组血清cTnI、CK-MB比较差异均无显著性(P＞0.05)。门静脉阻断1 h,观察组SDANN为(55.4±23.3)ms,显著低于对照组的(69.4±24.4)ms(P＜0.05)。【结论】 异丙酚与七氟醚对活体肝移植患者血流动力学及心肌损伤的影响并无明显差别,均伴无肝期心脏交感神经系统抑制、新肝期早期心脏交感神经系统失衡情况,且异丙酚无肝期交感神经系统抑制较七氟醚更为明显。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	刘苗苗
	步小贺
	安立新

关键词 ：肝移植/外科学, 二异丙酚/治疗应用, 醚类/治疗应用, 心肌疾病/并发症

收稿日期: 2019-03-15

PACS:

R657.3

引用本文:

刘苗苗, 步小贺, 安立新. 异丙酚与七氟醚复合麻醉对活体肝移植患者心肌损伤及心脏自主神经系统的影响[J]. 医学临床研究, 2020, 37(1): 116-119.

链接本文:

http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2020.01.037 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2020/V37/I1/116

[1] 赵宇, 祝瑜, 张代忠. 人脐带间充质干细胞肝内移植联合苦参素治疗失代偿期乙型肝炎肝硬化患者疗效与转归分析[J].实用肝脏病杂志, 2018, 21(3):44-47.
[2] 郑虹, 张海明, 郑卫萍. 肝移植后肝细胞癌复发的认知与思考[J].中华肝脏病杂志, 2018, 26(2):88-92.
[3] Lu Y,Wang L,Liu N,et al. Sevoflurane preconditioning in on-pump coronary artery bypass grafting: a meta-analysis of randomized controlled trials[J].J Anesth,2016, 30(6):977-986.
[4] Oikawa FTC,Hueb W,Nomura CH,et al. Abnormal elevation of myocardial necrosis biomarkers after coronary artery bypass grafting without established myocardial infarction assessed by cardiac magnetic resonance[J].J Cardiothorac Surg,2017, 12(1):122-128.
[5] 中华外科杂志编辑部.关于活体肝移植若干问题的专家共识[J].中华外科杂志,2008,46(8):561-563.
[6] Ganesh S, Almazroo OA, Tevar A, et al. Drug metabolism, drug interactions, and drug-induced liver injury in living donor liver transplant patients[J].Clin Liver Dis,2017, 21(1):181-196.
[7] Moharem HA,Fetouh FA,Darwish HM,et al. Effects of bacterial translocation on hemodynamic and coagulation parameters during living-donor liver transplant[J].BMC Anesthesiol,2018, 18(1):46-52.
[8] Huang S,Apinyachon W, Agopian VG, et al. Myocardial injury in patients with hemodynamic derangements during and/or after liver transplantation[J].Clin Transplantation,2016, 30(12):1552-1557.
[9] Yamada Y, Laube I , Jang JH , et al. Sevoflurane preconditioning protects from posttransplant injury in mouse lung transplantation[J].J Surg Res,2017, 214(15):270-277.
[10] Zhang Y, Lin W, Shen S, et al. Randomized comparison of sevoflurane versus propofol-remifentanil on the cardioprotective effects in elderly patients with coronary heart disease[J].BMC Anesthesiol,2017, 17(1):104-111.
[11] Yang XL, Wang D, Zhang GY, et al. Comparison of the myocardial protective effect of sevoflurane versus propofol in patients undergoing heart valve replacement surgery with cardiopulmonary bypass[J].BMC Anesthesiol,2017, 17(1):37-43.
[12] Fan J, Ma J, Xia N, et al. Clinical value of combined detection of CK-MB, MYO, cTnI and plasma NT-proBNP in diagnosis of acute myocardial infarction[J].Clin Lab,2017, 63(3):427-433.
[13] Lee J, Yoo YJ, Lee JM, et al. Sevoflurane versus desflurane on the incidence of postreperfusion syndrome during living donor liver transplantation: a randomized controlled trial[J].Transplantation,2016, 100(3):600-606.
[14] Scheiber C, Johnston L, Packer M, et al. Heart rate variability markers as correlates of survival in recipients of hematopoietic cell transplantation[J].Oncol Nursing Forum,2018, 45(2):250-259.
[15] Beckschimmer B , Bonvini J M , Schadde E , et al. Conditioning with sevoflurane in liver transplantation: results of a multicenter randomized controlled trial[J].Transplantation,2015, 99(8):1606-1612.