| 艾司洛尔对腹腔镜胃癌根治术患者血流动力学和心肌损伤的影响 |
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| 引用本文： | 乐新会,黄晓霞,张磊,赵栋.艾司洛尔对腹腔镜胃癌根治术患者血流动力学和心肌损伤的影响[J].中华全科医学,2018,16(2):229. |
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| 作者姓名： | 乐新会 黄晓霞 张磊 赵栋 |
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| 作者单位： | 金华市中心医院麻醉科, 浙江 金华 321000 |
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| 基金项目： | 杭州市科技型中小企业技术创新基金(2013-3-038)浙江省自然科学基金(2014PYA015) |
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| 摘 要： | 目的 研究艾司洛尔对腹腔镜胃癌根治术患者血流动力学、心肌损伤及术后镇痛的影响。 方法 选取2014年9月-2016年9月在金华市中心医院行腹腔镜胃癌根治术的患者84例,按照随机数字表法分为A组(42例)和B组(42例),A组插管前3 min静脉注射艾司洛尔0.3 mg/kg,术中持续静脉输注艾司洛尔至气管拔管,B组用生理盐水代替艾司洛尔,术后均采用静脉镇痛。比较2组患者在麻醉诱导前(T0)、输注艾司洛尔(或生理盐水)即刻(T1)、气管插管即刻(T2)、拔管即刻(T3)、拔管后10 min (T4)、拔管后20 min (T5)的平均动脉压(MAP)和心率(HR)的变化,比较2组患者在麻醉前和术后5 h、8 h的乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、血清肌钙蛋白I (cTnI)的浓度变化,比较2组患者的VAS镇痛评分。 结果 在T1、T2、T3、T4、T5时,2组患者在MAP和HR方面差异有统计学意义(P<0.05),且A组T5时刻的MAP和HR与T0时刻相比,差异无统计学意义(均P>0.05),B组T5时刻的MAP和HR与T0时刻相比,差异有统计学意义(均P<0.05);术后5 h 2组患者LDH、CK、CK-MB、cTnI浓度与麻醉前相比均有明显提高(P<0.05),术后8 h A组患者与术前相比差异无统计学意义(P>0.05),B组患者与术前相比差异有统计学意义(P<0.05);术后1 d、2 d,A组患者的静息痛和运动痛VAS评分明显低于B组(P<0.05),术后3 d,2组患者的静息痛和运动痛VAS评分比较差异无统计学意义(均P>0.05)。 结论 艾司洛尔治疗腹腔镜胃癌根治术患者后,可使血流动力学更加稳定,能够有效降低心肌损伤程度,术后镇痛效果好,具有积极的临床意义。
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| 关 键 词： | 艾司洛尔 腹腔镜胃癌根治术 血流动力学 心肌损伤 |
| 收稿时间： | 2017-05-19 |
Effects of Esmolol on hemodynamics and myocardial injury in patients undergoing laparoscopic radical gastrectomy |
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| Affiliation: | Department of Anesthesiology, Jinhua Central Hospital, Jinhua, Zhejiang 321000, China |
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| Abstract: | Objective To investigate the effects of Esmolol on hemodynamics, myocardial injury and postoperative analgesia in patients undergoing laparoscopic radical gastrectomy. Methods Eighty-four patients with laparoscopic radical gastrectomy in our hospital between September, 2014 and September, 2016 were enrolled into this study and divided into group A (n=42) and group B (n=42) according to random number table. Group A received intravenous injection of Esmolol 0.3 mg/kg 3 min before intubation, intraoperative continuous intravenous infusion of Esmolol until the time to extubation, group B received saline instead of Esmolol. The postoperative intravenous analgesia was performed. The changes of mean arterial pressure (MAP) and heart rate (HR) were observed before anesthesia induction (T0), at the time of injection of Esmolol (or saline) (T1), tracheal intubation (T2), extubation (T3), 10 min after extubation (T4), 20 min after extubation (T5). The levels of lactate dehydrogenase (LDH), creatine kinase (CK), creatine kinase isoenzyme (CK-MB) and serum troponin I (cTnI) were measured before and 5 hours after anesthesia. VAS analgesia scores were compared between the two groups. Results At the time of T1, T2, T3, T4 and T5, there was statistically significant in MAP and HR between the two groups (P<0.05), and there was no significant difference in MAP and HR between T5 and T0 in group A (P>0.05), and there was significant difference in MAP and HR between T5 and T0 in group B (P<0.05); The levels of LDH, CK, CK-MB and cTnI in 5 hours after the operation in the two groups were significantly lower than those before the operation (P<0.05). There was no significant difference in group A at 8 hours after operation as compared the preoperative results (P>0.05), however, there was significant difference in group B (P<0.05). The resting pain and exercise pain VAS score on d1 and d2 in group A were significantly lower than those in group B after the operation (P<0.05), however, there was no statistically significant difference on d3 after the operation (P>0.05). Conclusion For laparoscopic radical gastrectomy patients, Esmolol can make hemodynamic more stable, effectively reduce the degree of myocardial injury, with good postoperative analgesic effect. |
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