张铁峰, 蒋海斌, 安敏, 张拴军, 杨健美, 柴金花, 张蕾. 不同麻醉方案对冠状动脉搭桥术患者应激及苏醒质量的影响[J]. 心脏杂志, 2019, 30(1): 34-36, 53. DOI: 10.12125/j.chj.201806046
    引用本文: 张铁峰, 蒋海斌, 安敏, 张拴军, 杨健美, 柴金花, 张蕾. 不同麻醉方案对冠状动脉搭桥术患者应激及苏醒质量的影响[J]. 心脏杂志, 2019, 30(1): 34-36, 53. DOI: 10.12125/j.chj.201806046
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    Tie-Feng ZHANG, Hai-Bin JIANG, ming AN, Shuan-Jun ZHANG, Jian-Mei YANG, Jin-Hua CHAI, Lei ZHANG. Study on stress response and wake quality in patients of off-pump coronary artery bypass grafting under different anesthesia methods[J]. Chinese Heart Journal, 2019, 30(1): 34-36, 53. DOI: 10.12125/j.chj.201806046
    Citation: Tie-Feng ZHANG, Hai-Bin JIANG, ming AN, Shuan-Jun ZHANG, Jian-Mei YANG, Jin-Hua CHAI, Lei ZHANG. Study on stress response and wake quality in patients of off-pump coronary artery bypass grafting under different anesthesia methods[J]. Chinese Heart Journal, 2019, 30(1): 34-36, 53. DOI: 10.12125/j.chj.201806046
    shu

    不同麻醉方案对冠状动脉搭桥术患者应激及苏醒质量的影响

    Study on stress response and wake quality in patients of off-pump coronary artery bypass grafting under different anesthesia methods

      摘要
    • 摘要:
        目的   探讨静脉麻醉与不同浓度七氟烷吸入麻醉对冠状动脉搭桥术患者应激反应及苏醒状况的影响。
        方法   选取非体外循环冠脉搭桥手术患者90例，随机分为舒芬太尼+丙泊酚组（A组），舒芬太尼+丙泊酚+0.5MAC七氟烷组（B组），；舒芬太尼+丙泊酚+1.0MAC七氟烷组（C组），每组30例。记录各组不同时间点皮质醇，肾上腺素，去甲肾上素，血糖变化及HR、 MAP、手术持续时间、术后苏醒时间、ICU时间、住院天数。术后恶性呕吐发生率，苏醒期躁动发生情况。
        结果   3组皮质醇，肾上腺素、去甲肾上腺素、血糖与B、C组比较A组在T2、T3、时明显升高（P<0.05），B组与C组比较无统计学差异。B组MAP在手术结束时明显升高（P<0.05），HR明显降低（P<0.05）；B组苏醒时间，ICU时间最短（P<0.05）。A组恶心呕吐率高，术后躁动A最少。
        结论   七氟烷麻醉可减轻患者应激反应，且0.5MAC七氟烷血流动力学更稳定，ICU滞留时间短，但七氟烷麻醉苏醒躁动发生率高。

       

      Abstract:
        AIM   AIM To investigate the effects of intravenous anesthesia and different concentrations of sevoflurane on stress response and wake quality in patients with off-pump coronary artery bypass surgery.
        METHODS   Ninety patients aged 56 to 73 years under off-pump coronary artery bypass grafting surgery were randomly divided into sufentanil+propofol group (Group A), sufentanil+propofol+0.5 MAC sevoflurane group (Group B) and sufentanil and propofol+1.0 MAC sevoflurane group (Group C), with 30 cases in each group. Cortisol, epinephrine, norepinephrine, blood glucose, HR, MAP, duration of surgery, postoperative wake time, ICU time and hospitalization days were recorded at different time points in each group. The incidence of postoperative malignant vomiting and agitation during the waking period were also compared.
        RESULTS   Cortisol, epinephrine, norepinephrine and blood glucose at T2, T3 in Group A were significantly higher than those in Group B and Group C (P<0.05), while there was no statistically difference between Group B and Group C. In Group B, MAP was significantly higher at postoperative (P<0.05) and HR significantly was lower (P<0.05). Waking time and ICU time in Group B were the shortest (P<0.05). In Group A, the incidence of nausea and vomiting was higher, while that of agitation was the lowest.
        CONCLUSION   Anesthesia with sevoflurane can reduce the patient's stress response. Additionally, the hemodynamics of 0.5 MAC sevoflurane were more stable and ICU time was shorter, but the incidence of agitation was still high.

       

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