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-现代医学

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

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

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.

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