Bassuoni Ahmed S, Amr Yasser M
Department of Anesthesia and Intensive Care, Tanta University, Egypt.
Saudi J Anaesth. 2012 Apr;6(2):125-30. doi: 10.4103/1658-354X.97024.
The present study was conducted to evaluate the cardioprotective effect of sevoflurane compared with propofol in patients with coronary artery disease (CAD) undergoing peripheral vascular surgery; and to address the question whether a volatile anesthetic might improve cardiac outcome in these patients.
One hundred twenty-six patients scheduled for elective peripheral vascular surgery were prospectively randomized to receive either sevoflurane inhalation anesthesia or total intravenous anesthesia. ST-segment monitoring was performed continuously during intra- and post-operative 48 h periods. The number of ischemic events and the cumulative duration of ischemia in each patient were recorded. Blood was sampled in all patients for the determination of cTnI. Samples were obtained before the induction of anesthesia, on admission to the ICU, and at 6, 12, 24, and 48 h after admission to the intensive care unit (ICU). Patients were followed-up during their hospital stay for any adverse cardiac events.
The incidence of ischemia were comparable among the groups [16 (25%) patients in sevoflurane group vs 24 (39%) patients in propofol group; P=0.126]. Duration, cumulative duration, and magnitude of ST-segment depression of ischemic events in each patient were significantly less in sevoflurane group (P=0.008, 0.048, 0.038, respectively). cTnI levels of the overall population were significantly less in sevoflurane group vs propofol group (P values <0.0001) from 6 h postoperative and onward. Meanwhile, cTnI levels at 6, 12, 24, and 48 h after admission to the ICU in patients who presented with ischemic electrocardiographic (ECG) changes were significantly lower in sevoflurane group than in the propofol group (P<0.0001, <0.0001, <0.0001, 0.0003). None of the patients presented with unstable angina, myocardial infarction, congestive heart failure, or serious arrhythmia either during ICU or hospital stay.
Patients with CAD receiving sevoflurane for peripheral vascular surgery had significantly lower release of cardiac troponin I at 6 h postoperatively and lasting for 48 h than patients receiving propofol for the same procedure with significant decrease in duration, cumulative duration of ischemic events, and degree of ST depression in each patient.
本研究旨在评估七氟醚与丙泊酚相比，对接受外周血管手术的冠心病（CAD）患者的心脏保护作用；并探讨挥发性麻醉剂是否能改善这些患者的心脏预后。
126例计划接受择期外周血管手术的患者被前瞻性随机分为接受七氟醚吸入麻醉或全静脉麻醉。在手术期间及术后48小时内持续进行ST段监测。记录每位患者的缺血事件数量和缺血累积持续时间。采集所有患者的血液以测定肌钙蛋白I（cTnI）。样本在麻醉诱导前、入住重症监护病房（ICU）时以及入住ICU后6、12、24和48小时采集。在患者住院期间随访任何不良心脏事件。
两组之间的缺血发生率相当[七氟醚组16例（25%）患者，丙泊酚组24例（39%）患者；P = 0.126]。七氟醚组每位患者缺血事件的ST段压低持续时间、累积持续时间和幅度均显著更低（分别为P = 0.008、0.048、0.038）。术后6小时及以后，七氟醚组总体人群的cTnI水平显著低于丙泊酚组（P值<0.0001）。同时，出现缺血性心电图（ECG）变化的患者在入住ICU后6、12、24和48小时的cTnI水平，七氟醚组显著低于丙泊酚组（P<0.0001、<0.0001、<0.0001、0.0003）。在ICU期间或住院期间，没有患者出现不稳定型心绞痛、心肌梗死、充血性心力衰竭或严重心律失常。
与接受丙泊酚进行相同手术的患者相比，接受七氟醚进行外周血管手术的CAD患者术后6小时至48小时内心脏肌钙蛋白I的释放显著更低，且每位患者的缺血事件持续时间、累积持续时间和ST段压低程度显著降低。
