健忘镇痛慢诱导对老年冠心病患者全麻气管插管诱发QTc间期延长的影响

目的观察健忘镇痛慢诱导麻醉插管对老年冠心病患者QTc间期和血流动力学参数的影响.方法选择60例择期行中危开腹手术的老年冠心病患者,美国麻醉医师协会(ASA)分级Ⅱ级,年龄60-80岁,随机分为:健忘镇痛慢诱导组(J组)(n=30)和常规诱导组(C组)(n=30),分别采用健忘镇痛慢诱导和常规快速诱导.记录并分析诱导前(基础状态,T0)、气管插管前2min(T1)、1min(T2),气管插管即刻(T3),气管插管后30s(T4)、2min(T5)以及5min(T6)时的校正QT间期(QTc)、平均动脉压(MAP)和心率(HR).结果麻醉诱导及插管前后C组病人的MAP、HR和QTc值波动较明显(P<0.05),J组较平稳(P>0.05).插管后(T4-T6)C组QTc与插管前比较显著延长(P<0.05),J组变化不明显(P>0.05);与C组比较,J组插管后(T4-T6) QTc明显缩短(P<0.05).J组QTc异常发生率低于C组.结论采用健忘镇痛慢诱导可有效抑制气管插管诱发的QTc间期延长,同时可减弱插管时的血流动力学反应.

Effect of slow amnesia analgesia induction on endotracheal intubation-induced QTc interval in elderly patients with coronary heart disease

Objective To observe the effect of slow amnesia analgesia induction on endotracheal intubation-induced QTc interval and hemodynamic parameters in elderly coronary heart disease(CHD) patients.Methods Sixty ASA II CHD patients aged 6080 years were randomly divided into slow amnesia analgesia induction group(group J) and routine induction group(group C),30 in each group.Patients in group J were treated with slow amnesia analgesia induction and those in group C were treated with common rapid intravenous induction.Basic data before endotracheal induction(T0),2min before endotracheal intubation(T1),1min before endotracheal intubation(T2),immediate endotracheal intubation(T3),30s after endotracheal intubation(T4),2 min after endotracheal intubation(T5),5min after endotracheal intubation(T6),corrected QTc interval,mean artery pressure(MAP) and heart rate(HR) were recorded and analyzed.Results The fluctuation of QTc interval,MAP and HR was more stable in group C than in group J(P<0.05).The QTc interval was significantly longer in group C than in group J after intubation at T4-T6 than after intubation at T0(P<0.05).The T4-T6 were significantly shorter in group C after intubation than before intubation(P<0.05).The incidence of abnormal QTc interval was significantly lower in group J than in group C after intubation at T4-T6(P<0.05).Conclusion Slow amnesia analgesia induction can effectively shorten endotracheal intubation-induced QTc interval and decrease hemodynamic reactions during endotracheal intubation.