网站首页期刊介绍通知公告编 委 会投稿须知电子期刊广告合作联系我们
最新消息:
异丙酚静脉注射对老年患者左心室功能及心肌β肾上腺素能受体的影响
作者:向俊1  王志维2 
单位:1. 武汉大学人民医院 麻醉科, 湖北 武汉 430060;
2. 武汉大学人民医院 心胸外科, 湖北 武汉 430060
关键词:异丙酚 老年患者 左心室功能 心肌β肾上腺素能受体 
分类号:R614
出版年·卷·期(页码):2020·48·第十期(1249-1253)
摘要:

目的:通过临床试验探究异丙酚静脉注射对老年患者左心室功能及心肌β肾上腺素能受体的影响。方法:筛选2017年9月至2018年6月在我院进行外科手术的老年患者90例,采用靶控输注技术对手术患者进行全麻,监测围术期患者心率、血压以及心电图、超声心动图的心功能指标,静脉取血测定心肌β肾上腺素能受体亲和能力。结果:静脉注射异丙酚后,老年患者左心室收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)、射血分数(EF)、心脏指数(CI)、心输出量(CO)和每搏输出量(SV)均出现短时下降,5 min后恢复正常水平。静脉注射异丙酚后,老年患者心肌细胞β肾上腺素能受体亲和能力出现短时抑制,在诱导后即刻抑制效果最明显,诱导5 min后受体亲和能力有所上升,10 min后基本接近诱导前水平。结论:异丙酚对老年患者左心室功能及心肌β肾上腺素能受体有短时下调影响,术前了解患者病史及相关用药史至关重要。

Objective: To explore the effects of propofol intravenous injection on left ventricular function and myocardial beta adrenergic receptor in elderly patients by clinical trial.Methods: 90 elderly patients scheduled for surgery in our hospital from September 2017 to June 2018 were selected. The target controlled infusion technique was used for general anesthesia. Heart rate(HR), blood pressure, electrocardiogram, echocardiography and other cardiac function indexes were monitored. The affinity of myocardial β-adrenergic receptor was measured by venous blood sampling.Results: After intravenous injection of propofol, the left ventricular systolic blood pressure(SBP), diastolic blood pressure(DBP), mean arterial pressure(MAP), heart rate(HR), ejection fraction(EF), cardiac index(CI), cardiac output(CO) and per stroke output(SV) of the elderly patients were reduced in a short time and recovered to the normal level after 5 min. After intravenous injection of propofol, β-adrenoceptor affinity of cardiomyocytes in elderly patients was inhibited for a short time, and the inhibitory effect was most obvious at 0 min after induction, 5 min after induction, the affinity of receptor increased. After 10 min, it was close to the level before induction.Conclusion: Propofol has a short down regulation effect on left ventricular function and myocardial beta adrenergic receptor in elderly patients. It is essential to understand the medical history and medication history of the patients before operation.

参考文献:

[1] 盖赵辉,张云红,佟香芝,等.异丙酚和瑞芬太尼靶控静脉麻醉的诱导和术后苏醒过程评价[J].临床和实验医学杂志,2014,52(9):753-756.
[2] 杨宁,左明章,石妤.老年患者靶控输注异丙酚复合瑞芬太尼的药效学探讨[J].中华老年医学杂志,2013,32(3):312-314.
[3] KARANTH H,RAVEENDRA U S,SHETTY R B,et al.Comparative evaluation between sevoflurane and propofol for endotracheal intubation without muscle relaxants in pediatric cleft surgeries[J].Anesth Essays Res,2015,12(2):434-439.
[4] QIAO Y,FENG H,ZHAO T,et al.Postoperative cognitive dysfunction after inhalational anesthesia in elderly patients undergoing major surgery:the influence of anesthetic technique,cerebral injury and systemic inflammation[J].BMC Anesthesiol,2015,15:154-160.
[5] NI J,WEI J,YAO Y,et al.Effect of dexmedetomidine on preventing postoperative agitation in children:a meta-analysis[J].PLoS One,2015,10(5):e0128450.
[6] IWATA M,INOUE S,KAWAGUCHI M,et al.The effect of hypercapnia and hypertension on cerebral oxygen balance during one-lung ventilation for lung surgery during propofol anesthesia[J].J Clin Anesth,2010,22(8):608-613.
[7] MAO W,WEI X Q,TAO J,et al.The safety of combined sedation with propofol plus fentanyl for endoscopy screening and endoscopic variceal ligation in cirrhotic patients[J].J Dig Dis,2014,15(3):124-130.
[8] BAKAN M,UMUTOGLU T,TOPUZ U,et al.Opioid-free total intravenous anesthesia with propofol,dexmedetomidine and lidocaine infusions for laparoscopic cholecystectomy:a prospective,randomized,double-blinded study[J].Braz J Anesthesiol,2015,65(3):191-199.
[9] SPOLADORE R,FRAGASSO G,PERSEGHIN G,et al.Beneficial effects of beta-blockers on left ventricular function and cellular energy reserve in patients with heart failure[J].Fundam Clin Pharmacol,2013,27(4):455-464.
[10] DEKLEVA M,DVNGEN H D,GELBRICH G,et al.Beta blockers therapy is associated with improved left ventricular systolic function and sustained exercise capacity in elderly patients with heart failure[J].Aging Clin Exp Res,2012,24(6):675-681.
[11] BIENERT A,WAWRZYNIAK K,WICZLING P,et al.Melatonin and clonidine premedication has similar impact on the pharmacokinetics and pharmacodynamics of propofol target controlled-infusions[J].J Clin Pharmacol,2015,55(3):307-316.
[12] SATO M,SHIRAKAMI G,FUKUDA K.Comparison of general anesthesia and monitored anesthesia care in patients undergoing breast cancer surgery using a combination of ultrasound-guided thoracic paravertebral block and local infiltration anesthesia:a retrospective study[J].J Anesth,2016,30(2):244-251.
[13] GOTODA T,KUSANO C,NONAKA M,et al.Non-anesthesiologist administrated propofol(NAAP) during endoscopic submucosal dissection for elderly patients with early gastric cancer[J].Gastric Cancer,2014,17(4):686-691.
[14] ZHANG Y,LIN W,SHEN S,et al.Randomized comparison of sevoflurane versus propofol-remifentanil on the cardioprotective effects in elderly patients with coronary heart disease[J].BMC Anesthesiol,2017,17(1):104.
[15] MENG Q T,CAO C,LIU H M,et al.Safety and efficacy of etomidate and propofol anesthesia in elderly patients undergoing gastroscopy:a double-blind randomized clinical study[J].Exp Ther Med,2016,12(3):1515-1524.
[16] GOTODA T,OKADA H,HORI K,et al.Propofol sedation with a target-controlled infusion pump and bispectral index monitoring system in elderly patients during a complex upper endoscopy procedure[J].Gastrointest Endosc,2016,83(4):756-764.
[17] RUDNER R,JALOWIECKI P,KAWECKI P,et al.Conscious analgesia/sedation with remifentanil and propofol versus total intravenous anesthesia with fentanyl,midazolam,and propofol for outpatient colonoscopy[J].Gastrointest Endosc,2003,57(6):657-663.
[18] SIDDIK-SAYYID S M,AOUAD M T,TAHA S K,et al.A comparison of sevoflurane-propofol versus sevoflurane or propofol for laryngeal mask airway insertion in adults[J].Anesth Analg,2005,100(4):1204-1209.
[19] AYDOG∨AN M S,DEMIREL S,ERDOG∨AN M A,et al.Effects of ketamine-propofol mixture on intraocular pressure and haemodynamics in elderly patients:a randomised double-blind trial[J].Turk J Anaesthesiol Reanim,2014,42(1):12-18.
[20] WEIL B R,SUZUKI G,YOUNG R F,et al.Troponin release and reversible left ventricular dysfunction after transient pressure overload[J].J Am Coll Cardiol,2018,71(25):2906-2916.

服务与反馈:
文章下载】【发表评论】【查看评论】【加入收藏
提示:您还未登录,请登录!点此登录
您是第 410148 位访问者


 ©《现代医学》编辑部
联系电话:025-83272481;83272479
电子邮件: xdyx@pub.seu.edu.cn

苏ICP备09058541