| Objectives To investigate the effect of sevoflurane inhalation on perioperative myocardial protection in elderly patients with coronary heart disease(CHD)who underwent noncardiac surgery,we observed the changes of perioperative vital signs,serum cardiac troponin I and creatine kinase isoenzyme.Methods In this study,120 elderly patients with coronary heart disease undergoing laparoscopic colorectal cancer radical operation were randomly divided into three groups(n=40)by digital table method,which were the sevoflurane inhalation process group(T group),the sevoflurane inhalation half course group(H Group),all by vein group(C group).All three groups were induced by intravenous drug injection and maintained during the operation: Group C was treated with propofol and remifentanil by intravenous pump;group T used continuous inhalation of sevoflurane(end-respiratory concentration stable at 1 MAC)combined with propofol until the end of surgery;the maintenance method of the first 2 hours after intubation in the H group was the same as that of the T group,and the maintenance method after 2 hours was the same as that of the C group until the end of the operation.Map,HR,Co,CI,LCW and SVR were collected at seven time points: respectively before anesthesia induction(Ta0),before tracheal intubation(Ta1),1 min after tracheal intubation(Ta2),at the beginning of operation(Ta3),2 h after sevoflurane inhalation(Ta4),at the end of operation(Ta5),and 5 min after extubation(Ta6).The venous blood was drawn at five time points: 5min before induction(Tb0),end of surgery(Tb1),12h(Tb2),24h(Tb3),and 48h(Tb4)and the serum cardiac troponin I(c Tn I)and creatine kinase isoenzymes(CK-MB)were measured.The days from the end of operation to discharge,the dosage of remifentanil and the VAS score were compared.Results 1 In the MAP index,the values at time Ta1,Ta3,and Ta4 in the three groups were significantly lower than those at time Ta0(P<0.05);In the HR indicators,the values at the time of Ta1,Ta3,and Ta4 in the three groups were significantly lower than those at time of Ta0;and the values of the T and H groups were significantly lower than those of the C group at Ta4(P<0.05);In the CO index,the values of time Ta3 and time C4 in the three groups were significantly lower than time Ta0(P<0.05);In the CI index,the values of time Ta2,Ta3,and time Ta4 in groups H and C were significantly lower than time Ta0(P<0.05);In the SVR index,the values at the time of Ta1,Ta2,Ta3,and Ta4 in the three groups were significantly lower than those of Ta0,and the SVR at T4 of the T and H groups was lower than that of the C group at the same time(P<0.05);In the LCW index,the values of Ta1,Ta3,and Ta4 in the three groups were significantly lower than those in Ta0(P<0.05).2 The level of serum c Tn I in the three groups increased gradually from the end of operation,and it was significantly higher from the time point of Tb2 to tb4 than that before operation,and the level of c Tn I in the T and H groups was significantly lower than that in the C group(P<0.05);The serum CK-MB concentration of the three groups increased gradually from the end of the operation,and decreased after reaching the peak at Tb3,but the level was still significantly higher at the time point from Tb2 to tb4 than before the operation,and the level of CK-MB in the T and H groups was significantly lower than that in the C group in this period(P<0.05).3 The dosage of remifentanil in group C was more than that in group H was more than that in group T,the difference was statistically significant(P<0.05);there was no statistical difference in the days from the end of operation to the discharge and the VAS score after operation among the three groups(P>0.05).Conclusions 1 Studies have shown that compared with propofol anesthesia,sevoflurane anesthesia can produce myocardial protection,reduce myocardial infarction and maintain hemodynamics in elderly patients with coronary heart disease.2 At the same depth of anesthesia,the use of sevoflurane inhalation combined anesthesia can reduce the amount of analgesic and sedative drugs compared with intravenous anesthesia.3 Whether different sevoflurane inhalation duration can produce more effective myocardial protection still needs larger sample size,longer observation time and more in-depth clinical basic research.Figure12;Table4;Reference 134... |
PDF Full Text Request