摘要
目的分析丙泊酚不同血浆靶浓度对老年患者心室复极的影响。方法采用随机数字表法将2016年1月-2017年12月某院行择期手术的老年患者60例分为3组,每组20例。所有患者均接受注射咪达唑仑、芬太尼、依托咪酯、顺阿曲库铵麻醉诱导及吸入七氟醚麻醉维持。所有患者术中静吸复合维持先给予1.0μg/kg右美托咪定的负荷量10min后,靶控输注丙泊酚,根据血浆靶控浓度分组分别为丙泊酚1.0μg/ml(A组)、2.0μg/ml(B组)、4.0μg/ml(C组)。分别于麻醉诱导前、手术开始后1小时、拔管后30分钟,观察记录三组患者生命体征指标、心室复极指标及炎症因子水平变化。结果麻醉诱导前,三组SpO2、HR、SBP及DBP比较差异无统计学意义,P>0.05;手术开始后1小时、拔管后30分钟,C组Sp O2显著低于A组、B组,HR、SBP及DBP显著高于A组、B组。麻醉诱导前,三组QT间期、QTc间期、T波峰-末间期及Tp-e/QT比较差异无统计学意义,P>0.05;手术开始后1小时、拔管后30分钟,三组QT间期、QTc间期、T波峰-末间期及Tp-e/QT比较差异有统计学意义,P<0.05,其中B组、C组QT间期、QTc间期、T波峰-末间期及Tp-e/QT显著低于A组,P<0.05。麻醉诱导前,三组IL-6、IL-10水平比较差异无统计学意义,P>0.05;手术开始后1小时、拔管后30分钟,三组IL-6、IL-10水平比较差异有统计学意义,P<0.05,其中B组、C组IL-6显著低于A组、IL-10显著高于A组,P<0.05。结论对于老年患者,靶控输注丙泊酚2～4.0μg/ml能够缩短患者已经延长的QT间期,呈现剂量依赖性,但是高剂量对循环影响较大,需根据患者情况选择合适剂量。
Objective To analyze the effects of target-controlled infusion of propofol with different concentrations on ventricular repolarization in elderly patients.Methods 60 elderly patients from January 2016 to December 2017 who underwent elective surgery in a hospital,by a random number table method these patients were divided into three groups,20 cases in each group.All patients were given imidazolam,fentanyl,etomidate,ciprofloquamonium and inhaled sevoflurane anesthesia.Then the patients were target-controlled infused of propofol 1.0μg/ml(A group),3μg/ml(B group) and 4μg/ml(C group) in target plasma concentration,respectively.After the inductionof anaesthesia,1 h after operation and 30 min after extubation,the indicators of vital signs,ventricular complex and inflammatory factors in the three groups were observed.Results Before anesthesia induction,SpO2,HR,SBP and DBP in three groups had no significant difference(P>0.05).1 h after operation and 30 min after tube extraction,SpO2 in group C was significantly lower than that in group A and group B,and HR,SBP and DBP were significantly higher than those in A group and B group.Before anesthesia induction,QT interphase,QTc,T wave-at the end of the period and Tp-e/QT in three groups had no significant difference(P>0.05).1 h after operation and 30 min after tube extraction,QT interphase,QTc,T wave-at the end of the period and Tp-e/QT in three groups had significant difference(P<0.05).In group B and group C,QT interphase,QTc,T wave-at the end of the period and Tp-e/QT were significantly lower than those in A group(P<0.05).Before anesthesia induction,IL-6 and IL-10 in three groups had no significant difference(P>0.05).1 h after operation and 30 min after tube extraction,IL-6 and IL-10 in three groups had significant difference(P<0.05).The IL-6 in group B and group C was significantly lower than that in group A and IL-10 in group B and group C was significantly higher than that in group A(P<0.05).Conclusion For elderly patients,2~4.0μg/ml target controlled infusion of propofol can shorten the QT interphase and has dose dependent,but the high dose has a great effect on circulation,and the appropriate dosage should be selected according to the patient’s condition.
作者
余建华
李振威
彭健泓
刘莱莉
陈汝涛
Yu Jianhua;Li Zhenwei;Peng Jianhong;Liu Laili;Chen Rutao(Department of Anesthesiology, Foshan Hospital of Traditional Chinese Medicine,Foshan528000, Guangdong Province, China)
出处
《中国病案》
2018年第12期98-101,共4页
Chinese Medical Record
关键词
丙泊酚
靶控输注
心室复极
QT间期
老年
Propofol
Target control infusion
Ventricular repolarization
QT interphase
Elderly patients
