Bulte Carolien S E, van den Brom Charissa E, Loer Stephan A, Boer Christa, Bouwman R Arthur
Department of Anaesthesiology, Institute for Cardiovascular Research, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
Cardiovasc Diabetol. 2014 Mar 23;13:62. doi: 10.1186/1475-2840-13-62.
In type 2 diabetic patients, cardiac events in the perioperative period may be associated with diminished myocardial vasomotor function and endothelial dysfunction. The influence of sevoflurane anaesthesia on myocardial endothelial dysfunction in type 2 diabetic mellitus is investigated in this pilot study.
Six males with type 2 diabetes mellitus and eight healthy controls were included. Using myocardial contrast echocardiography, myocardial blood flow (MBF) was measured at rest, during adenosine-induced hyperaemia (endothelium-independent vasodilation) and after sympathetic stimulation by the cold pressor test (endothelium-dependent vasodilation). Measurements were performed before and after induction of sevoflurane anaesthesia.
Sevoflurane anaesthesia decreased resting MBF in diabetics but not in controls (P = 0.03), while baseline MBF did not differ between diabetics and controls. Without anaesthesia, adenosine-induced hyperaemia increased MBF in both groups compared to resting values. Adenosine combined with sevoflurane resulted in a lower hyperaemic MBF in both groups compared to no anaesthesia. Differences in MBF in response to adenosine before and after sevoflurane administration were larger in diabetic patients, however not statistically significant in this pilot group (P = 0.08). Myocardial blood flow parameters after the cold pressor test were not different between groups.
These pilot data in type 2 diabetic patients show that sevoflurane anaesthesia decreases resting myocardial blood flow compared to healthy controls. Further, we observed a trend towards a lower endothelium-independent vasodilation capacity in diabetic patients under sevoflurane anaesthesia. Endothelium-dependent vasodilation was not affected by sevoflurane in diabetic patients. These data provide preliminary insight into myocardial responses in type 2 diabetic patients under general anaesthesia.
http://www.clinicialtrials.gov, NCT00866801.
在2型糖尿病患者中，围手术期心脏事件可能与心肌血管舒缩功能减退和内皮功能障碍有关。本初步研究探讨了七氟醚麻醉对2型糖尿病患者心肌内皮功能障碍的影响。
纳入6名2型糖尿病男性患者和8名健康对照者。使用心肌对比超声心动图，在静息状态、腺苷诱导的充血期间（非内皮依赖性血管舒张）以及冷加压试验交感神经刺激后（内皮依赖性血管舒张）测量心肌血流量（MBF）。在七氟醚麻醉诱导前后进行测量。
七氟醚麻醉使糖尿病患者的静息MBF降低，但对照组未降低（P = 0.03），而糖尿病患者和对照组的基线MBF无差异。未麻醉时，与静息值相比，腺苷诱导的充血使两组的MBF均增加。与未麻醉相比，腺苷联合七氟醚使两组的充血MBF降低。七氟醚给药前后对腺苷反应的MBF差异在糖尿病患者中更大，但在该初步研究组中无统计学意义（P = 0.08）。冷加压试验后的心肌血流参数在两组之间无差异。
这些2型糖尿病患者的初步数据表明，与健康对照者相比，七氟醚麻醉降低了静息心肌血流量。此外，我们观察到七氟醚麻醉下糖尿病患者非内皮依赖性血管舒张能力有降低的趋势。糖尿病患者的内皮依赖性血管舒张不受七氟醚影响。这些数据为全身麻醉下2型糖尿病患者的心肌反应提供了初步见解。
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