贵州医科大学学报

2020, v.45;No.233(02) 214-218

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不同浓度地氟醚对妇科手术患者心电图QTc、QTd、QTcd、Tp-e和Tp-e与QT比值的影响
Effects of Different Concentrations of Desflurane on Electrocardiographic QTc,QTd,QTcd,Tp-e and Tp-e/QT in Patients with Gynecologic Surgery

刘艳秋,彭寒梅,王厚钧,夏阳,黄岁岁,陈惠
LIU Yanqiu,PENG Hanmei,WANG Houjun,XIA Yang,HUANG Suisui,CHENG Hui

摘要(Abstract):

目的:观察不同浓度地氟醚对心率校正QT间期(QTc)、QT离散度(QTd)、心率校正QT离散度(QTcd)、Tp-e间期(Tp-e)及Tp-e与QT(Tp-e/QT)比值的影响。方法:择期行妇科女性手术患者60例、ASA分级Ⅰ或Ⅱ级,采用随机数字表法均分为D_1组、D_2组及D_3组,统一麻醉方案诱导后气管内插管,行机械通气,使D_1组、D_2组和D_3组地氟醚浓度维持在06、13和20 MAC;于诱导前(T_1)、地氟醚达设定浓度后10 min(T_2)、15 min(T_3)、20 min(T4)时采集12导联心电图,测量计算QTc、QTd、QTcd、Tp-e及Tp-/QT比值,同时记录平均动脉压(MAP)和心率(HR)。结果:与T_1比较,T_(2-4)时D_1~D_3组MAP下降,D_1~D_2组HR减慢,D_3组HR增快,差异有统计学意义(P<005);与D_1和D_2组比较,D_3组T_(2-4)时HR增快,差异有统计学意义(P<005);与T_1比较,T_(2-4)时D_1~D_3组QTc延长,D_1~D_2组Tp-e/QT比值减小,差异有统计学意义(P<005);QTd、QTcd及Tp-e各组不同时点间比较,差异无统计学意义(P> 005)。结论:低于20 MAC浓度地氟醚吸入维持麻醉不会增大患者心肌复极异质性,心律失常发生风险低。
Objective: To observe the effects of different concentrations of desflurane on QTc interphase(QTc) QT dispersion(QTd), heart rate corrected QT dispersion(QTcd), Tp-e interval/QT radio(Tp-e ASAⅠ ~ Ⅱ, scheduled for elective surgery were randomly divided into Group D_1, Group D_2 and Group D_3 with 20 in each group. After induction of unified anaesthesia program, the patients received tracheal intubation and mechanical ventilation. With the desflurane evaporator opened, the concentrations of desflurane in D_1, D_2, and D_3 maintained at 0. 6 MAC, 1. 3 MAC, and 2. 0 MAC respectively. 12-lead ECG was collected before induction(T_1) and 10(T_2), 15(T_3), and 20 minutes(T4) after desflurane reached the set concentration. QTc,QTd, QTcd, Tp-e, and Tp-e/QTwere measured and calculated. Meanwhile, mean arterial pressure(MAP) and heart rate(HR) wererecorded.Results: Hemodynamic index: Compared with T_1, MAP decreased in Groups D_1~ D_3, HR slowed down in Groups D_1~ D_2, HR increased in Group D_3 at T_(2-4)(P< 0. 05). Compared with GroupD_1 and D_2,HR increased in Group D_3 at T_(2-4)(P< 0. 05). Electrophysiological index: Compared withT_1, the QTc interval of Groups D_1~ D_3 prolonged, and Tp-e/QT ratio of Groups D_1~ D_2 decreased at T_(2-4)(P< 0. 05). There was no significant difference in QTd,QTcd,Tp-e interval in Groups D_1~ D_3 atdifferent time points(P> 0. 05).Conclusions: Inhalation maintenance anesthesia with desfluraneconcentration below 2. 0 MAC can not increase cardiac repolarization heterogeneity in patients withgynecologic surgeries, and the risk of arrhythmia was low.

关键词(KeyWords): 麻醉药;心电描记术;地氟醚;心律失常;妇科手术
anesthetics;electrocardiography;desflurane;arrhythmia;gynecologic surgery

Abstract:

Keywords:

基金项目(Foundation): 贵州省科技厅联合基金资助项目[黔科合LH字(2015)7424]

作者(Author): 刘艳秋,彭寒梅,王厚钧,夏阳,黄岁岁,陈惠
LIU Yanqiu,PENG Hanmei,WANG Houjun,XIA Yang,HUANG Suisui,CHENG Hui

DOI: 10.19367/j.cnki.1000-2707.2020.02.017

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