Zhang X K, Hu Q, Chen Q H, Wang W X
Pharmazie. 2017 Aug 1;72(8):487-489. doi: 10.1691/ph.2017.6992.
We evaluated the effect of continuous perfusion of esmolol on cardiovascular risk during curative laparoscopic surgery for gastrointestinal cancer in elderly patients. Sixty patients with gastrointestinal cancer, aged from 60 to 80 years, were divided into an esmolol group (ES, n = 30) and a control group (NS, n = 30). ES patients were treated with esmolol at a dose of 0.3 mg/kg 3 min before tracheal intubation, and received continuous perfusion of esmolol at a dose of 50 μg/kg/min during operation. In NS, esmolol was replaced by saline. SBP/DBP, MAP, HR, SPO2, PETCO2, the depth of anesthesia and the value of RPP were recorded before anesthesia (T0), during intubation (T1), 10 min before pneumoperitoneum (T2), during pneumoperitoneum (T3), 30 min after incision (T4), at the end of surgery (T5), during extubation (T6) and 30 min after extubation (T7). The serum levels of cTnI, CK, CK-MB and LDH were measured before anesthesia, 6 and 30 h after surgery. HR, MAP, RPP at T1, T3, T6 in ES were obviously decreased compared with NS (P < 0.05). There were no significant differences between both groups at different time points with respects to the serum levels of cTnI, CK, CK-MB and LDH. No major adverse cardiocerebral event was observed in both groups in three postoperative months. The present study indicated that the application of esmolol during curative laparoscopic surgery for gastrointestinal cancer can effectively reduce the cardiovascular responses in intubation, operation and extubation, sustain hemodynamic stable, reduce myocardial oxygen consumption, and prevent perioperative adverse cardiovascular events, but had no significant myocardial protective effect.
我们评估了持续输注艾司洛尔对老年胃肠道癌患者根治性腹腔镜手术期间心血管风险的影响。60例年龄在60至80岁之间的胃肠道癌患者被分为艾司洛尔组（ES组，n = 30）和对照组（NS组，n = 30）。ES组患者在气管插管前3分钟给予0.3 mg/kg的艾司洛尔，并在手术期间以50 μg/kg/min的剂量持续输注艾司洛尔。在NS组中，用生理盐水替代艾司洛尔。记录麻醉前（T0）、插管期间（T1）、气腹前10分钟（T2）、气腹期间（T3）、切口后30分钟（T4）、手术结束时（T5）、拔管期间（T6）和拔管后30分钟（T7）的收缩压/舒张压、平均动脉压、心率、血氧饱和度（SPO₂）、呼气末二氧化碳分压（PETCO₂）、麻醉深度和心率收缩压乘积（RPP）值。在麻醉前、术后6小时和30小时测量血清肌钙蛋白I（cTnI）、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）和乳酸脱氢酶（LDH）水平。与NS组相比，ES组在T1、T3、T6时的心率、平均动脉压、心率收缩压乘积明显降低（P < 0.05）。两组在不同时间点的血清cTnI、CK、CK-MB和LDH水平无显著差异。术后三个月两组均未观察到重大的心脑血管不良事件。本研究表明，在胃肠道癌根治性腹腔镜手术中应用艾司洛尔可有效降低插管、手术和拔管期间的心血管反应，维持血流动力学稳定，降低心肌耗氧量，预防围手术期不良心血管事件，但无明显的心肌保护作用。
