氙气与异氟烷对择期手术患者左心室功能影响的多中心随机对照研究

Multicenter randomized comparison of xenon and isoflurane on left ventricular function in patients undergoing elective surgery.

作者信息

Wappler Frank, Rossaint Rolf, Baumert Jan, Scholz Jens, Tonner Peter H, van Aken Hugo, Berendes Elmar, Klein Jan, Gommers Diederik, Hammerle Alfons, Franke Andreas, Hofmann Thomas, Schulte Esch Jochen

机构信息

Department of Anesthesiology, University Hospital Hamburg-Eppendorf, and Department of Anesthesiology and Intensive Care Medicine, University Witten/Herdecke, Germany.

出版信息

Anesthesiology. 2007 Mar;106(3):463-71. doi: 10.1097/00000542-200703000-00010.

DOI:10.1097/00000542-200703000-00010

PMID:17325504

Abstract

BACKGROUND

Volatile anesthetics are commonly used for general anesthesia. However, these can induce profound cardiovascular alterations. Xenon is a noble gas with potent anesthetic and analgesic properties. However, it is uncertain whether xenon alters myocardial function. The aim of this study was therefore to investigate left ventricular function during anesthesia with xenon compared with isoflurane.

METHODS

The authors performed a randomized multicenter trial to compare xenon with isoflurane with respect to cardiovascular stability and adverse effects in patients without cardiac diseases scheduled for elective surgery. Two hundred fifty-nine patients were enrolled in this trial, of which 252 completed the study according to the protocol. Patients were anesthetized with xenon or isoflurane, respectively. Before administration of the study drugs and at four time points, the effects of both anesthetics on left ventricular function were investigated using transesophageal echocardiography.

RESULTS

Global hemodynamic parameters were significantly altered using isoflurane (P < 0.05 vs. baseline), whereas xenon only decreased heart rate (P < 0.05 vs. baseline). In contrast to xenon, left ventricular end-systolic wall stress decreased significantly in the isoflurane group (P < 0.05 vs. baseline). Velocity of circumferential fiber shortening was decreased significantly in the xenon group but showed a more pronounced reduction during isoflurane administration (P < 0.05 vs. baseline). The contractile index (difference between expected and actually measured velocity of circumferential fiber shortening) as an independent parameter for left ventricular function was significantly decreased after isoflurane (P < 0.0001) but unchanged using xenon.

CONCLUSIONS

Xenon did not reduce contractility, whereas isoflurane decreased the contractile index, indicating that xenon enables favorable cardiovascular stability in patients without cardiac diseases.

摘要

背景

挥发性麻醉剂常用于全身麻醉。然而，这些药物可引起严重的心血管改变。氙是一种具有强效麻醉和镇痛特性的惰性气体。然而，氙是否会改变心肌功能尚不确定。因此，本研究的目的是比较氙与异氟烷麻醉期间的左心室功能。

方法

作者进行了一项随机多中心试验，比较氙与异氟烷对计划进行择期手术的无心脏病患者的心血管稳定性和不良反应。259例患者纳入本试验，其中252例按方案完成研究。患者分别接受氙或异氟烷麻醉。在给予研究药物前及四个时间点，使用经食管超声心动图研究两种麻醉剂对左心室功能的影响。

结果

使用异氟烷时，整体血流动力学参数发生显著改变（与基线相比，P<0.05），而氙仅使心率降低（与基线相比，P<0.05）。与氙不同，异氟烷组左心室收缩末期壁应力显著降低（与基线相比，P<0.05）。氙组圆周纤维缩短速度显著降低，但在使用异氟烷期间降低更为明显（与基线相比，P<0.05）。作为左心室功能独立参数的收缩指数（预期与实际测量的圆周纤维缩短速度之差）在使用异氟烷后显著降低（P<0.0001），而使用氙时未改变。