体外循环冠状动脉搭桥手术中挥发性与非挥发性药物心脏保护作用的比较。
A comparison of volatile and non volatile agents for cardioprotection during on-pump coronary surgery.
作者信息
De Hert S, Vlasselaers D, Barbé R, Ory J-P, Dekegel D, Donnadonni R, Demeere J-L, Mulier J, Wouters P
机构信息
Division of Cardiothoracic and Vascular Anaesthesiology, Academic Medical Center, Amsterdam, Netherlands.
出版信息
Anaesthesia. 2009 Sep;64(9):953-60. doi: 10.1111/j.1365-2044.2009.06008.x.
A randomised study of 414 patients undergoing coronary artery surgery with cardiopulmonary bypass was conducted to compare the effects of a volatile anaesthetic regimen with either deesflurane or sevoflurane, and a total intravenous anaesthesia (TIVA) regimen on postoperative troponin T release. The primary outcome variable was postoperative troponin T release, secondary outcome variables were hospital length of stay and 1-year mortality. Maximal postoperative troponin T values did not differ between groups (TIVA: 0.30 [0.00-4.79] ng x ml(-1) (median [range]), sevoflurane: 0.33 [0.02-3.68] ng x ml(-1), and desflurane: 0.39 [0.08-3.74] ng x ml(-1)). The independent predictors of hospital length of stay were the EuroSCORE (p < 0.001), female gender (p = 0.042) and the group assignment (p < 0.001). The one-year mortality was 12.3% in the TIVA group, 3.3% in the sevoflurane group, and 6.7% in the desflurane group. The EuroSCORE (p = 0.003) was the only significant independent predictor of 1-year mortality.
一项针对414例行体外循环冠状动脉手术患者的随机研究开展，以比较使用地氟烷或七氟烷的挥发性麻醉方案与全静脉麻醉（TIVA）方案对术后肌钙蛋白T释放的影响。主要结局变量为术后肌钙蛋白T释放，次要结局变量为住院时间和1年死亡率。术后肌钙蛋白T的最大值在各组间无差异（TIVA组：0.30 [0.00 - 4.79] ng x ml⁻¹（中位数[范围]），七氟烷组：0.33 [0.02 - 3.68] ng x ml⁻¹，地氟烷组：0.39 [0.08 - 3.74] ng x ml⁻¹）。住院时间的独立预测因素为欧洲心脏手术风险评估系统（EuroSCORE）（p < 0.001）、女性性别（p = 0.042）和分组（p < 0.001）。TIVA组的1年死亡率为12.3%，七氟烷组为3.3%，地氟烷组为6.7%。欧洲心脏手术风险评估系统（p = 0.003）是1年死亡率唯一显著的独立预测因素。
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