Filipovic M, Michaux I, Wang J, Hunziker P, Skarvan K, Seeberger M
Department of Anaesthesia, University of Basel Hospital CH-4031 Basel, Switzerland.
Br J Anaesth. 2007 Jan;98(1):12-8. doi: 10.1093/bja/ael277. Epub 2006 Oct 22.
The effects of anaesthetics on left ventricular (LV) diastolic function in patients with pre-existing diastolic dysfunction are not well known. We hypothesized that propofol but not sevoflurane will worsen the pre-existing LV diastolic dysfunction.
Of 24 randomized patients, 23 fulfilled the predefined echocardiographic criterion for diastolic dysfunction. They received general anaesthesia with sevoflurane 1 MAC (n=12) or propofol 4 mug ml(-1) (n=11). Echocardiographic examinations were performed at baseline and in anaesthetized patients under spontaneous breathing and under positive pressure ventilation. Analysis focused on peak early diastolic velocity of the mitral annulus (E(a)).
During spontaneous breathing, E(a) was higher in the sevoflurane than in the propofol group [mean (95% CI) 7.0 (5.9-8.1) vs 5.5 (4.7-6.3) cm s(-1); P<0.05], reflecting an increase of E(a) from baseline only in the sevoflurane group (P<0.01). Haemodynamic findings were similar in both groups, but the end-tidal carbon dioxide content was more elevated in the propofol group (P<0.01). During positive pressure ventilation, E(a) was similarly low in the sevoflurane and propofol groups [5.3 (4.2-6.3) and 4.4 (3.6-5.2) cm s(-1), respectively].
During spontaneous breathing, early diastolic function improved in the sevoflurane but not in the propofol group. However, during positive pressure ventilation and balanced anaesthesia, there was no evidence of different effects caused by the two anaesthetics.
麻醉药对已有舒张功能障碍患者左心室（LV）舒张功能的影响尚不明确。我们推测丙泊酚而非七氟醚会使已有的左心室舒张功能障碍恶化。
24例随机分组患者中，23例符合舒张功能障碍的预定义超声心动图标准。他们接受了七氟醚1 MAC（n = 12）或丙泊酚4μg/ml（n = 11）的全身麻醉。在基线时以及麻醉状态下自主呼吸和正压通气时进行超声心动图检查。分析重点为二尖瓣环舒张早期峰值速度（E(a)）。
自主呼吸期间，七氟醚组的E(a)高于丙泊酚组[均值（95%可信区间）7.0（5.9 - 8.1）对5.5（4.7 - 6.3）cm/s；P < 0.05]，这反映仅七氟醚组的E(a)较基线有所增加（P < 0.01）。两组的血流动力学结果相似，但丙泊酚组的呼气末二氧化碳含量升高更明显（P < 0.01）。正压通气期间，七氟醚组和丙泊酚组的E(a)同样较低[分别为5.3（4.2 - 6.3）和4.4（3.6 - 5.2）cm/s]。
自主呼吸期间，七氟醚组舒张早期功能改善，丙泊酚组则未改善。然而，在正压通气和平衡麻醉期间，没有证据表明两种麻醉药会产生不同影响。
