丙泊酚联合依托咪酯在心脏瓣膜置换术中的应用

目的:观察丙泊酚联合依托咪酯在心脏瓣膜置换术中的应用。方法:60例行心脏瓣膜置换术患者按随机数字表法均分为丙泊酚组(P组)、依托咪酯组(E组)、依托咪酯+丙泊酚组(M组)。P组患者给予丙泊酚静脉麻醉;E组患者给予依托咪酯静脉麻醉;M组患者给予依托咪酯+丙泊酚静脉麻醉。观察3组患者诱导前2 min、诱导后2 min及插管后2 min心率(HR)、收缩压(SBP)、舒张压(DBP)、中心静脉压(CVP)和血氧饱和度(SPO2),麻醉诱导前(T1)、主动脉阻断前(T2)、主动脉阻断30 min(T3)、主动脉开放30 min(T4)、主动脉开放2 h(T5)、主动脉开放24 h(T6)时的血清肌钙蛋白I(cTnI)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)及不良反应发生情况。结果:P组患者诱导后2 min、插管后2 min SBP、DBP、HR、CVP均显著低于诱导前2 min以及E组和M组(P<0.05);插管后2 min SBP、DBP、HR均显著高于诱导后2 min(P<0.05)。E组患者诱导后2 min、插管后2 min HR均显著低于诱导前2 min,插管后2 min DBP显著高于诱导后2 min(P<0.05),HR显著低于M组(P<0.05);M组患者诱导后2 min DBP、HR显著低于诱导前2 min(P<0.05)。3组患者T3、T4、T5、T6时cTnI、CK-MB、CK均显著高于T1、T2时(P<0.05);E组患者T3、T4、T5、T6时cTnI、CK-MB、CK均显著高于P组和M组(P<0.05)。3组患者麻醉期间SPO2无明显变化且均未见明显不良反应发生。结论:丙泊酚联合依托咪酯可用于心脏瓣膜置换术,具有较好的心肌保护作用,且诱导时更加平稳。

Application of Propofol Combined with Etomidate in Cardiac Valve Replacement

OBJECTIVE： To observe the application of propofol combined with etomidate in cardiac valve replacement. METH- ODS： 60 patients undergoing cardiac valve replacement were randomly divided into propofol group （group P）, etomidate group （group E） and etomidate＋propofol group （group M）. Group P was given intravenous anesthesia of propofol, group E was given intravenous anesthesia of etomidate, and group M was given intravenous anesthesia of etomidate and propofol. The heart rate （HR）, systolic and diastolic blood pressure （SBP and DBP）, central venous pressure （CVP） and oxygen saturation of blood SPO2 were observed in 3 groups 2 min before induction, 2 min after induction and 2 min after intubation. The serum cTnI, CK, CK-MB and ADR were observed before induction （T1）, before aortic cross-clamping （T2）, 30 min after aortic cross-clamping （T3）, 30 min af- ter aortic declamping （T4）, 2 h after aortic declamping （T5） and 24 h after aortic declamping （T6）. RESULTS： 2 min after induction and 2 min after intubation, SBP, DBP, HR and CVP of group P were significantly lower than 2 min before induction those of group E and M; there was statistical significance （P〈0.05） ; SBP, DBP and HR 2 min after incubation were significantly higher than 2 min after induction （P〈0.05）. HR of group E 2 min after induction and 2 min after incubation were significantly lower than 2 min before induction; DBP of group E 2 min after incubation was significantly higher rthan 2 rain after induction （P〈0.05）. HR of group E was significantly lower than that of group M 2 min after induction （P〈0.05）. DBP and HR of group M 2 rain after in- duction were significantly lower than 2 min before induction （P〈0.05）. SPO2 of 3 groups had no significant change. The plasma level of cTnI, CK and CK-MB at T3, and T4, T5 and T6 were significantly higher than at T1 and T2 （P〈0.05）. The plasma level of cTnI, CK and CK-MB in group E were significantly higher than in group P and M at T3, T4, T5 and T6 （P〈0.05）. No significant ADR was found in 3 groups during anesthesia. CONCLUSIONS： Propofol combined with etomidate can be used for cardiac valve replacement and effective protect cardiac muscle and induce anesthesia steadily.