许国琴,莫怀忠,向梅,陈伟,王念,范成都
XU Guoqin,MO Huaizhong,XIANG Mei,CHENG Wei,WANG Nian,FAN Chengdu

• 1:贵阳医学院麻醉学系
• 2:贵州省肿瘤医院

摘要(Abstract)：

目的:比较七氟烷或丙泊酚对喉罩置入患者QT间期及血流动力学的影响。方法:选择ASA分级Ⅰ~Ⅱ级在择期全身麻醉下行腹腔镜胆囊切除术的女性患者60例,随机分为七氟烷吸入麻醉诱导组及丙泊酚全凭静脉麻醉诱导组,两组患者在静脉注射舒芬太尼3 min后分别吸入3.5%七氟烷或靶控丙泊酚效应室浓度3.5 mg/L,患者睫毛反射消失后静脉注射维库溴铵3 min后喉罩置入;记录舒芬太尼静脉注射前(T0)、舒芬太尼静脉注射后3 min(T1)、七氟烷吸入或丙泊酚靶控后睫毛反射消失后(T2)、维库溴铵静脉注射后3 min(T3)、喉罩置入即刻(T4)、喉罩置入后2 min(T5)时的无创血压、心率、QT间期及校正QT(QTc)。结果:两组T1~T5时刻血压及心率均较T0时下降,丙泊酚组T2~T5血压及心率较七氟烷组下降更明显(P<0.05);与T0时刻比较,两组T1时间点QTc均延长,丙泊酚组T2~T5时点QTc恢复到T0水平(P<0.05),喉罩置入时QTc间期未延长,七氟烷组T2~T5时点与T1时点较QTc持续延长(P<0.05),喉罩置入时QTc明显延长。结论:七氟烷吸入麻醉诱导时循环稳定,但患者QT间期延长,在喉罩置入时QT间期进一步延长;而丙泊酚静脉麻醉诱导对血流动力学影响较大,但患者QT间期缩短,在喉罩置入时QT间期未见延长。
Objective: To compare two different anesthetic inductionmethods on QT interval and hemodynamics of patients with laryngeal mask insertion. Method: Sixty female patients of ASA classification Ⅰ ~ Ⅱ who had laparoscopic cholecystectomy operation under general anesthesia,randomly divided into sevoflurane inhalation anesthetic induction group( group S,n = 30) and propofol intravenous anesthetic induction group( group P,n = 30). Both groups were intravenously injected sufentanil and inhaled 3. 5% sevoflurane or target controlled infusion of propofol at 3. 5 mg / L 3 minutes after injection. Once eyelash reflection disappeared,intravenously injected vecuronium bromide and inserted laryngeal mask 3 minutes later. It was recorded that the non-invasive blood pressure,heart rate,QT,QTc respectively at the time before intravenously injected sufentanil( T0),3 minutes after intravenously injected sufentanil( T1),time of eyelash reflection disappeared after Sevoflurane inhalation or after propofol target controlled infusion( T2),3 minutes after intravenously injected vecuronium bromide( T3),the moment of laryngeal mask insertion( T4) and 2 minutes after laryngeal mask insertion( T5).Results: Both groups' blood pressure and heart rate were dropped at T1- 5compared to T0,T2- 5blood pressure and heart rate of group P significantly dropped more than group S'( P < 0. 05). The variation of QTc: compare to T0,both groups' QTc at T1 are extended; compared to T1,QTc of group P at T2- 5reduced and regained T0's level( P < 0. 05),the QT interval on laryngeal mask insertion was not extended. Compared to T1,the QTc of Group S was extended( P < 0. 05),the QT interval on laryngeal mask insertion is extended significantly. Conclusions: Sevoflurane inhalation anesthetic induction is hemodynamicly stable,but it will prolong patients' QT intervals and continuously prolong QT intervals,while laryngeal mask inserting; propofol intravenously anesthetic induction have more influence on haemodynamics,but it can reduce the QT intervals of patients.

关键词(KeyWords)： 七氟烷;丙泊酚;麻醉,全身;QT间期
sevoflurane;propofol;anesthesia,general;QT interval

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 许国琴,莫怀忠,向梅,陈伟,王念,范成都
XU Guoqin,MO Huaizhong,XIANG Mei,CHENG Wei,WANG Nian,FAN Chengdu

DOI: 10.19367/j.cnki.1000-2707.2015.02.014

参考文献(References)：

• [1]Peter J.Zimetbaum,Mark E.Josephson.临床心脏电生理基础与精要[M].天津:科技翻译出版公司,2010:122-125.
• [2]庄心良,曾因明,陈伯銮,等.现代麻醉学[M].2版.北京:人民卫生出版社,2003:446-489.
• [3]Adachi YU,Takamatsu I,Watanabe K,et al.Evaluation of the cardiovascular responses to fiberoptic orotracheal intubation with television monitoring;comparison with conventional direct laryngoscopy[J].J Clin Anesth,2000(7):503-508.
• [4]Kleitmasser A,Kuenazberg E,Lo-kinger A,et al.Sevoflurane,but not propofol,significantly prolongs the Q-T intervai[J].Anesch Analg,2000(1):25-27.
• [5]Christine A,Kenyon,Randall F,et al.Anesthesia for vidoscopic left cardiac sympathetic denervation in children with econgenital long QT syndrome and catecholaminergic polymorphic ventricular tachycardia-a case series[J].Pediatric Anesthesia,2010(5):465-470.
• [6]李小刚,周荣胜.七氟醚和丙泊酚对肥胖患者全麻诱导时P波离散度、QTc及QTc离散度的影响[J].陕西医学,2013(3):289-291.
• [7]徐晶,李妍,张文胜,等.麻醉药引起获得性长QT综合征的机制分析及防治建议[J].中国药物评价,2012(1):7-9.
• [8]Cowan JC,Yusoff K,Moore M,et al.Importance of lead selection in QT interval measurement[J].American Journal of Cardiology,1988(1):83-87.
• [9]张莹,庄心良,李士通,等.异丙酚、硫喷妥钠对大鼠心肌细胞钙、钾通道电流的影响[J].中华麻醉学杂志,2004(9):673-676.
• [10]王龙,王唏,周青山,等.异丙酚对兔心室M细胞和外膜层心肌细胞动作电位特性的影响[J].中华麻醉学杂志,2008(12):1078-1080.
• [11]Schmeling WT,warltier DC,Mc Donald D,et al.Pmlortgation of the QT interval by enflurane.isoflurane,and halothane in humans[J].Anesth Analg,1991(2):137-144.
• [12]Shigeo Ohmura,Toshikazu Ohta,Ken Yamamoto,et al.A comparison of the effects of propofol and sevoflurane on the systemic toxicity of intravenous Bupivacaine in rats[J].Anesth Analg,1999(1):155-159.
• [13]王龙,王唏,周青山,等.异氟烷对兔心室动作电位及跨室壁离散度的影响[J].中华麻醉学杂志,2007(10):632-635.

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