Kimura Seishi, Nakao Shinichi, Kitaura Atsuhiro, Iwamoto Tatushige, Houri Kei, Matsushima Mayuka, Hamasaki Shinichi
Department of Anesthesiology, Kindai University Faculty of Medicine, OsakaSayama, Osaka, Japan.
PLoS One. 2017 Dec 1;12(12):e0188555. doi: 10.1371/journal.pone.0188555. eCollection 2017.
QTc interval prolongation is a serious diabetic complication and increases mortality rate. Hyperglycemia inhibits the rapid component of delayed rectifier potassium channel currents (Ikr) and prolongs the QTc interval on electrocardiograms. Sevoflurane also inhibits the Ikr and causes QTc interval prolongation. In fact, torsade de pointes occurred in a patient with poorly controlled diabetes mellitus during sevoflurane anesthesia. We enrolled 74 patients, including 37 normoglycemic patients (glycated hemoglobin [HbA1c]: <6.5%) (NG group) and 37 chronically hyperglycemic patients (HbA1c: ≥6.5%) (HG group). Anesthesia was induced with 2 mg/kg propofol and 0.3 μg/kg/min remifentanil, and maintained with 2% sevoflurane in 40% O2 and 0.2-0.3 μg/kg/min remifentanil. The QT interval and Tp-e interval (from the peak to the end of the T wave) were measured before and at 5, 10, 30, 60, 90, and 120 min after the administration of sevoflurane and adjusted for the patient's heart rate (QTc and Tp-ec, respectively). P-values of <0.05 were considered statistically significant. The QTc and the Tp-ec intervals of the two groups did not differ significantly before the administration of sevoflurane. The QTc interval gradually increased with time in both groups and was significantly longer than the baseline value at 10 min after the administration of sevoflurane in both groups. The QTc interval of the HG group was significantly longer than that of the NG group at 90 min and 120 min after the administration of sevoflurane. The Tp-ec interval was not affected by sevoflurane in either group.We have demonstrated that sevoflurane significantly prolongs the QTc interval, and that the extent of the prolongation is significantly greater in chronically hyperglycemic patients than in normoglycemic patients. Although Tp-ec is not affected by sevoflurane, it should be noted that the simultaneous blockade of potassium channels would increase the risk of arrhythmias.
QTc间期延长是一种严重的糖尿病并发症，会增加死亡率。高血糖会抑制延迟整流钾通道电流（Ikr）的快速成分，并延长心电图上的QTc间期。七氟醚也会抑制Ikr并导致QTc间期延长。事实上，一名糖尿病控制不佳的患者在七氟醚麻醉期间发生了尖端扭转型室速。我们纳入了74例患者，包括37例血糖正常患者（糖化血红蛋白[HbA1c]：<6.5%）（NG组）和37例慢性高血糖患者（HbA1c：≥6.5%）（HG组）。用2mg/kg丙泊酚和0.3μg/kg/min瑞芬太尼诱导麻醉，并用2%七氟醚在40%氧气中及0.2 - 0.3μg/kg/min瑞芬太尼维持麻醉。在给予七氟醚前以及给药后5、10、30、60、90和120分钟测量QT间期和Tp - e间期（从T波峰值到终点），并根据患者心率进行校正（分别为QTc和Tp - ec）。P值<0.05被认为具有统计学意义。在给予七氟醚前，两组的QTc和Tp - ec间期无显著差异。两组的QTc间期均随时间逐渐增加，且在给予七氟醚后10分钟时均显著长于基线值。在给予七氟醚后90分钟和120分钟时，HG组的QTc间期显著长于NG组。两组中Tp - ec间期均不受七氟醚影响。我们已经证明七氟醚会显著延长QTc间期，并且慢性高血糖患者的延长程度显著大于血糖正常患者。虽然Tp - ec不受七氟醚影响，但应注意钾通道的同时阻断会增加心律失常的风险。
