艾司洛尔对老年冠心病患者气管插管QTc间期的影响

目的 评价艾司洛尔在麻醉诱导气管插管时对老年冠心病患者QTc间期的影响.方法 50例ASA Ⅱ级,年龄60～75岁择期全麻手术患者随机分为艾司洛尔组(E组)与对照组(C组).E组麻醉诱导前单次静脉缓慢注射艾司洛尔0.3 mg/kg后100 μg·kg-1·min-1持续输注至气管插管后4 mim;C组给予等容量生理盐水.记录给予艾司洛尔前(T0)、单次给予艾司洛尔或生理盐水后2 min(T1)、芬太尼与丙泊酚诱导后1 min(T2)、维库溴铵后3 min(插管前,T3)及插管后30 s(T4)、2 min(T5)与4 min(T6)QTc、MAP及HR变化.结果 T4～T6时QTc间期C组均长于T0时(P＜0.05),且C组明显长于E组(P＜0.01),其中QTc＞440 ms者C组显著多于E组(P＜0.05).结论 麻醉诱导气管插管期间老年冠心病患者QTc间期延长,而艾司洛尔可缩短与气管插管有关的QTc间期延长.     

不同剂量艾司洛尔复合异丙酚对气管插管时应激反应的影响

目的 了解艾司洛尔预防气管插管引起的血流动力学变化的合理用量。方法 30例病人随机分为3组。A组为对照组,B组为0．5mg.kg^-1艾司洛尔组,C组为1．0mg.kg^-1艾司洛尔组。静注异丙酚和维库溴铵诱导气管内插管。监测插管后1、3、5及10min收缩压（SP）、舒张压（DP）、心率（HR）;并抽取血标本用高压液相色谱仪测血浆中去甲肾上腺素（NE）、肾上腺素（E）和多巴胺（DA）浓度。结果 A组插管后1min时血压、心率显著升高（P＜0．01）或0．05）。B组插管后3、5及10min时血压、心率显著降低（P＜0．01或0．05）;3及5min时去甲肾上腺素与肾上腺素水平显著降低（P＜0．01或0．05）,与B组比较,插管后1和3min时肾上腺素水平显著降低（P＜0．01）。结论 1．0mg.kg^-1艾司洛尔复合异丙酚可缓解插管时的循环反应及儿茶酚胺反应。     

艾司洛尔对全麻病人气管插管诱发QT间期延长的影响

气管插管可诱发交感神经兴奋和血中儿茶酚胺浓度升高,从而诱发QT间期延长,QT间期延长可增加心律失常和猝死的发生率~([1-2]).有研究表明,艾司洛尔可抑制气管插管诱发的心血管反应~([3]).本研究拟评价艾司洛尔对全麻病人气管插管诱发QT间期延长的影响,为临床应用提供参考.     

艾司洛尔预防气管插管血液动力学的改变

目的：评价国产盐酸艾司涤尔预防气管插管血液动力学改变的临床效果。方法：１００例择期手术病人随机分在３组，Ａ组Ｅ１．０ｍｇ／ｋｇ．Ｂ组Ｅ２．０ｍｇ／ｋｇ，Ｃ组生理直１０ｍｌｚ。观察给药前、插管前、插管后１、２、３、５、１０分钟三组ＳＰ、ＤＰ、ＨＲ、ＲＰＰ变化。结果：Ａ、Ｂ两组用Ｅ后ＨＲ减慢，尤其插管后３分钟和１０分钟与Ｃ组比较有显著差异；Ｃ组插管后ＳＰ在１和３分钟增高极显著，至１０分钟仍高于插管前及     

阿芬太尼和艾司洛尔对气管插管时循环和儿茶酚胺反应的影响

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QT间期延长综合征病人的麻醉

不论是先天性ＱＴ间期延长综合征（ＬＱＴＳ）,还是后天性ＬＱＴＳ,由于麻醉手术可能诱发致命性室性心律失常,所以手术前早期诊断、正确治疗是极为重要的,麻醉医师应了解麻醉药对ＱＴ间期的影响,了解围手术期ＬＱＴＳ病人有可能发五的情况及处理原则。     

QT间期延长综合征病人的麻醉

不论是先天性QT间期延长综合征(LQTS),还是后天性LQTS,由于麻醉手术可能诱发致命性室性心律失常,所以手术前早期诊断、正确治疗是极为重要的,麻醉医师应了解麻醉药对QT间期的影响,了解围手术期LQTS病人有可能发生的情况及处理原则。     

静脉麻醉药对QT间期的影响

QT间期是指QRS波开始到T波结束,代表心室的除极和复极两个过程。QT间期延长可引起突发性室性心律失常或室颤而导致猝死,在麻醉和手术期间危险性极大。本研究目的是观察临床常用静脉全麻药对QT间期的影响,以提高麻醉安全性。 资料和方法 选ASAⅠ级择期全麻手术病人45例,男性27例,女性18例,年龄14～45岁,体重35～70kg。五官科手术39例,胸部手术6例,随机分为硫喷妥钠组、异丙酚组和依托咪酯组。全部病例术前均无心血管及肝肾疾患,生化检查:钠、钾、氯、钙、磷、镁在正常范围,心电图检查QT间期和QTc正常。术前肌注安定10mg,入手术室后测血压、脉搏、用日本产5403型三笔式心电图机描记心电图做术前对照。三组患者分别用硫喷妥     

气管插管时脑血管血液动力学变化及艾司洛尔的平抑作用

目的 探讨气管插管对脑血管血液动力学的影响及艾司洛尔（ＥＳＭ）的平抑作用，方法 ９３例的择期手术病人，随机分成：ＥＳＭ０ｍｇ．ｋｇ＾－１（对照组）ＥＳＭ，１ｍｇ．ｋｇ＾－１组ＥＳＭ２ｍｇ．ｋｇ＾－１组，检测麻醉前，插管后１，５，１０分脑血管血液动力学指标（ＣＶＤＩ）及体循环血压，心率。结果 （１）与插管前相比，插管后平均脑血流速度（Ｖｍｅａｎ）平均脑血管流量（Ｑｍｅａｎ）脑血管阻力比（Ｒｔ），临床     

The effect of esmolol on the QTc interval during induction of anaesthesia in patients with coronary artery disease

The aim of this study was to evaluate whether esmolol has an effect on QT interval during induction of anaesthesia using etomidate and fentanyl in patients with known coronary artery disease. Sixty patients were prospectively randomised to either a control group or the esmolol group. Esmolol was administered as a bolus 1 mg.kg⁻¹, followed by a continuous infusion at 250 μg.kg⁻¹min⁻¹. All patients received etomidate 0.3 mg.kg⁻¹ and fentanyl 15 μg.kg⁻¹. The ECG was recorded prior to induction of anaesthesia (T0), 5 min following the start of drug infusions (T1), 1 min following etomidate (T2), 3 min following vecuronium (T3), 30 s (T4), 2 min (T5) and 4 min (T6) after intubation. In the esmolol group, QTc interval was significantly shorter at T1, T2 and T4 compared to the control group (p < 0.05). In conclusion, QTc interval increased following tracheal intubation during induction of anaesthesia using etomidate and fentanyl. An infusion of Esmolol attenuated the QTc interval prolongation associated with tracheal intubation.     

QTc interval and QTc dispersion during haemodiafiltration

BACKGROUND and AIM: Our aim was to evaluate QTc interval and QTc dispersion in 27 end-stage renal disease (ESRD) patients undergoing Acetate Free Biofiltration (AFB) in order to ascertain any correlations between the electrrocardiographic (ECG) parameters, serum Na+, K+, Ca++, Mg++ and intraerythrocytic Mg++ (Mg++e) concentrations. All measures were made at t0 (session beginning), t1 (first hour), t2 (second hour), t3 (third hour), and t4 (session end). RESULTS: Blood pressure, heart rate, bodyweight and total ultrafiltration in the three dialysis sessions were constant. A significant progressive increase occurred in serum Ca++ during the sessions, while there was a significant diminution in serum K+. The pattern for Mg++ concentrations in serum and erythrocytes differed: in serum it decreased, whereas Mg++e increased. At t4, the QTc interval was reduced to a significant extent with respect to the baseline value. QTc dispersion significantly increased at t1 without there being significant variations at other times with respect to t0. At t2, t3 and t4, values promptly returned to baseline levels. QTc had a negative correlation with serum Ca++ levels at t4. In contrast, an inverse correlation was found between QTc dispersion and serum K+ at t1. No other correlations could be found between any other electrolytes, QTc interval or QTc dispersion. CONCLUSION: In conclusion, the decrease observed in the QTc interval at the end of an AFB session was inversely related to serum Ca++ concentrations. Moreover, an increase in QTc dispersion occurred during the first hour of the session, and was negatively correlated with serum K+.     

不同剂量雷米芬太尼对全麻诱导期血液动力学和血浆皮质醇浓度的影响

目的观察不同剂量雷米芬太尼诱导插管对血液动力学和血浆皮质醇浓度的影响。方法40例全麻病人随机均分为四组:芬太尼组(Ⅰ组,芬太尼2μg/kg)和不同剂量雷米芬太尼组(Ⅱ组0·5μg/kg,Ⅲ组1·0μg/kg,Ⅳ组1·25μg/kg)。诱导使用咪唑安定0·025mg/kg、芬太尼2μg/kg或雷米芬太尼0·5、1·0、1·25μg/kg、丙泊酚1·5mg/kg和罗库溴铵0·7mg/kg。分别于麻醉诱导前1min、诱导后1min及插管后3min内每隔1分钟记录SBP、DBP、HR,分别在诱导前5min、插管后4、6min测血浆皮质醇浓度。结果各组在诱导后SBP、DBP均明显下降,其中Ⅲ、Ⅳ组下降更明显。插管后,Ⅰ、Ⅱ组SBP、DBP明显上升,HR增快。Ⅲ、Ⅳ组SBP分别在插管后2、1min下降。各时点Ⅲ、Ⅳ组SBP、DBP、HR与Ⅰ组相比显著下降。Ⅰ、Ⅱ组血浆皮质醇浓度在插管后4min明显上升。结论雷米芬太尼1·0、1·25μg/kg虽可以有效抑制气管插管引起的心血管不良反应,但诱导期间低血压和呼吸抑制的发生率较高。     

不同剂量芬太尼复合丙泊酚对小儿全麻诱导期应激反应的影响

目的观察不同剂量芬太尼诱导气管插管对小儿血流动力学和血浆肾上腺素(E)、去甲肾上腺素(NE)的影响。方法40例择期全麻患儿,按不同剂量芬太尼随机均分四组:Ⅰ组1.0μg/kg,Ⅱ组2.0μg/kg,Ⅲ组2.5μg/kg,Ⅳ组3.0μg/kg。诱导使用咪唑安定0.1mg/kg,芬太尼1.0、2.0、2.5、3.0μg/kg,丙泊酚2.5mg/kg和维库溴铵0.1mg/kg。分别于麻醉诱导前(T0)、诱导后2min(T1)、插管后1、2min(T2、T3)记录HR、SBP和DBP。分别于T0、插管后3、5min(T4、T5)测血浆E和NE浓度。结果与T0时比较,各组患儿在T1时SBP、DBP均明显下降(P<0.05或P<0.01);T2、T3时Ⅰ组SBP明显增高(P<0.01),DBP增高,HR增快,但差异无统计学意义;Ⅱ~Ⅳ组SBP有所下降(P<0.05或P<0.01)。T1~T3时Ⅱ~Ⅳ组SBP及Ⅲ、Ⅳ组DBP较Ⅰ组降低(P<0.05或P<0.01);Ⅳ组HRT1时较Ⅰ组减慢(P<0.05)。T2、T3时Ⅱ~Ⅳ组HR较Ⅰ组减慢(P<0.05)。Ⅰ组血浆E和NE浓度在T4时明显上升(P<0.05或P<0.01)。结论芬太尼2.0~2.5μg/kg能较好地抑制小儿全麻诱导气管内插管时的应激反应。     

QT interval of the ECG, heart rate and arterial pressure during anaesthetic induction: comparative effects of alfentanil and esmolol

In a double-blind study the effect of esmolol and alfentanil on the QT interval of the ECG corrected by the heart rate (QTc), heart rate and arterial pressure during anaesthetic induction was studied in 59 oxycodone- and atropine-premedicated ASA class I-(II) patients with a mean age of 26 yr (range 15–50 yr). The patients were randomly allocated to one of the four groups: saline, esmolol 2 mg · kg^-1, esmolol 3 mg · kg^-1 or alfentanil 0.03 mg·kg^-1. Both doses of esmolol prevented the prolongation of the QTc interval after thiopental and suxamethonium, but not after laryngoscopy and intubation. Alfentanil prevented the prolongation of the QTc interval following thiopental, suxamethonium and laryngoscopy but not after intubation. Esmolol did not prevent the increase in the heart rate and arterial pressure in response to laryngoscopy and intubation. No cardiovascular responses to laryngoscopy and intubation occurred in the patients treated with alfentanil. No cardiac arrhythmias occurred in the esmolol 3 mg·kg^-1 group, whereas the frequency of ventricular ectopic beats was 40% in the saline group and 13–20% m the other groups.     

The effect of bolus administration of remifentanil on QTc interval during induction of sevoflurane anaesthesia

Stimulation of the sympathetic nervous system associated with tracheal intubation causes corrected QT (QTc) interval prolongation. We postulated that the use of remifentanil during induction of anaesthesia might prevent this. Sixty unpremedicated, ASA grade 1 patients were selected and randomly allocated to receive either saline (group S), remifentanil 0.5 microg x kg(-1) (group R 0.5) or remifentanil 1.0 microg x kg(-1) (group R1.0) 1 min before laryngoscopy. The QTc interval was significantly prolonged immediately following intubation in group S and group R0.5, but it remained stable in group R1.0, compared with the QTc interval just before laryngoscopy. It is concluded that the administration of remifentanil 1.0 microg x kg(-1) before intubation can prevent the prolongation of the QTc interval associated with tracheal intubation during induction of anaesthesia with sevoflurane.     

The effects of sevoflurane and desflurane anesthesia on QTc interval and cardiac rhythm in children

BACKGROUND: Inhalational anesthetics may prolong QTc interval (QT interval corrected for heart rate) of the ECG and cause life-threatening arrythmias. The effects of desflurane on QTc interval and cardiac rhythm have not been reported previously in children. We assessed the effects of desflurane anesthesia on QTc interval and cardiac rhythm and compared them with sevoflurane anesthesia in children. METHODS: The study was performed on 20 children admitted for inguinal hernia repair, with normal QTc intervals. Anesthesia was induced with propofol and intubation was achieved with vecuronium. Anesthesia was maintained with 2% sevoflurane (group I, n = 11) or 6% desflurane (group II, n = 9) and 66% nitrous oxide in oxygen. Electrocardiogram recordings were obtained by Holter recorder. QTc intervals were measured at baseline, 5, 10, 15, and 30 min after inhalation. RESULTS: None of the patients had significant arrythmia with desflurane anesthesia. One patient in the sevoflurane group had single, bigemini and multiform ventricular extrasystoles. There was no statistically significant difference in the baseline QTc values of the groups. Desflurane significantly prolonged QTc interval 5 min after induction until 30 min of anesthesia compared with baseline values (P = 0.029), while no significant prolongation was observed with sevoflurane (P = 0.141). CONCLUSIONS: Use of 2% sevoflurane during maintenance of anesthesia does not significantly prolong QTc interval while 6% desflurane significantly prolonged QTc interval in children with normal QTc interval undergoing inguinal herniorrhaphy.     

Impact of haemodialysis on QTc dispersion in children

BACKGROUND: The purpose of the present paper was to investigate the corrected QT (QTc) interval and QTc dispersion value, and the impact of haemodialysis on these parameters in children with chronic renal failure. METHODS: Nineteen patients with chronic renal failure receiving haemodialysis were included in the present study. Electrocardiography (ECG), echocardiography and serum biochemistry were performed in all patients. Serum electrolyte levels were measured before and after haemodialysis, at the time of the ECG. Nineteen healthy age- and sex-matched children served as the control group. RESULTS: Patients with chronic renal failure had greater QTc interval and QTc dispersion compared to control subjects. The patients' sex, age and presence of hypertension or left ventricular hypertrophy (LVH) were not related to QTc interval/dispersion. However, the patients with left ventricular (LV) systolic dysfunction had significantly greater QTc dispersion value. After haemodialysis session, both QTc interval and QTc dispersion values significantly increased. Serum potassium levels significantly decreased, whereas the calcium level significantly increased after the haemodialysis session. The changes in electrolyte values were not associated with the changes in both QTc interval and QTc dispersion. CONCLUSION: Children receiving haemodialysis may be at greater risk of ventricular arrhythmia and sudden death because QTc dispersion reflects heterogeneous recovery of ventricular excitability.     

曲吗多静脉诱导时对心血管反应的影响

采用经食管无创伤超声血流测定仪监测４５例择期手术病例，随机分三组：巨组，安定０．４ｍｇ／ｋｇ； Ⅱ组，咪唑安定０．３ｍｍ／ｋｍ；Ⅲ组，依托咪酯０． ３ｍｍ／ｋｍ。三组病例均静注曲吗多４ｍｇ／ｋｇ、阿曲可林０．５ｍｇ／ ｋｇ，观察插管前、插管时、插管后心排血量（ＣＯ）、心脏指数（ＣＩ）、周围血管阻力（ＳＶＲ）、平均动脉压（ＭＡＰ）、心率（ＨＲ）的变化。结果表明用曲吗多后 ＨＲ减慢， Ⅰ、Ⅱ组 ＣＯ、ＣＩ、ＭＡＰ下降，Ⅲ组 ＭＡＰ、ＣＯ、ＣＩ、无明显变化，插管时，插管后ＣＯ、ＣＩ、ＭＡＰ、ＨＲ无显著变化（Ｐ＞０．０５）。提示曲吗多有预防插管时的心血管副反应作用。