丙泊酚和依托咪酯对二尖瓣置换术中的心肌损伤的影响.docVIP

精品论文 参考文献 丙泊酚和依托咪酯对二尖瓣置换术中的心肌损伤的影响 南方医科大学附属衡阳医院麻醉科 湖南衡阳 421001 【摘 要】目的 研究患者在进行二尖瓣置换术过程中，丙泊酚和依托咪酯对心肌的影响。方法 选择二尖瓣置换术病例32例，将其随机分为观察组和对照组。按照分组分别采用依托咪酯及丙泊酚作为麻醉镇静剂。记录两组HR、SBP、SDP、MAP和CVP的变化。结果 诱导后3min（S2）时，观察组在SBP、DBP 和MAP的降幅较对照组小，组间比较差异有统计学意义（Plt;0.01），两组与诱导前比较，差异无统计学意义（Plt;0.01）。术中组间无明显差异。S2时，对照组心率较观察组下降明显，组间比较差异存在统计学意义（Plt;0.01）。所有病例诱导期间血氧饱和度均维持在100%，中心静脉压改变没有差异，无临床特殊含义。术中丙二醛逐渐升高，手术后12h（T3）较麻醉前（T1）升高明显（Plt;0.05），观察组较对照组升高明显（Plt;0.05）。皮质醇术中主动脉开放5min（T2）时升高明显，组间及组内比较差异均具有显著性（Plt;0.05）。T3时刻观察组下降较明显优于对照组（Plt;0.05）。结论 丙泊酚较依托咪酯对心肌损伤低，且无明显皮质醇抑制作用，能安全用于术中镇静。而依托咪酯适用于全麻诱导，术中镇静需慎用。 【关键词】丙泊酚；依托咪酯；二尖瓣置换术；心肌损伤 Effects of propofol and etomidate on myocardial injury in the mitral valve replacement Liao Ping （Department of Anesthesiology，the Affiliated Hospital of Hengyang，Southern Medical University，Hengyang，Hunan，421001，China） Abstract：Objective To investigate the effects of propofol and etomidate on myocardial injury in patients with mitral valve replacement.Method 32 cases of mitral valve replacement were chosen and randomly divided into observation group and control group.The value of HR，SBP，SDP，MAP，and changes of CVP were recorded.Results In 3 min after induction（S2），the control group showed significant difference than the control group in SBP，DBP，and MAP，when comparing before and after induction（P lt; 0.01）.，the difference was statistically significant（P lt; 0.01）.No significant differences between groups before induction.S2，controls heart rate decreased significantly in the observation group，comparing differences between group there is statistical significance（P lt; 0.01）.All cases induced during the blood oxygen saturation were maintained at 100%，there is no difference between central venous pressure changes，no clinical special meaning.Intraoperative malondialdehyde rise gradually，12 h（T3）after surgery than before anesthesia（T1）increased obviously（P lt; 0.05），the observation group than the control group increased significantly（P lt; 0.05）.Cortisol in