Rooke G A, Ebert T, Muzi M, Kharasch E D
Department of Anesthesiology, University of Washington, Seattle 98195, USA.
Anesth Analg. 1996 Jun;82(6):1159-65. doi: 10.1097/00000539-199606000-00010.
In patients without significant cardiovascular disease, the hemodynamic effects of sevoflurane and isoflurane are similar; however, the hemodynamic effects of sevoflurane in patients with hypertension and ischemic heart disease are unknown. To examine the effects of sevoflurane in comparison to isoflurane in this high-risk population, 214 patients scheduled for elective surgery were enrolled if they had evidence of ischemic heart disease or multiple risk factors for ischemic heart disease. Patients were randomly assigned to receive sevoflurane (n = 106) or isoflurane (n = 108) for anesthetic maintenance in conjunction with fentanyl and nitrous oxide in oxygen. Deviations in arterial blood pressure or heart rate of more than 20% from preinduction values that persisted after adjustment of the volatile anesthetic concentration were treated with intravenous phenylephrine, ephedrine, nitroglycerin, atropine, or esmolol as needed. Creatinine, blood urea nitrogen (BUN), and urine protein were measured before surgery, immediately after surgery, and 24 and 48 h postoperatively. For analysis, patients were divided into those with and those without the diagnosis of chronic hypertension. Heart rate and arterial blood pressure responses to sevoflurane and isoflurane were not different for the patients with or without chronic hypertension. Neither anesthetic was associated with a more frequent treatment for hemodynamic deviation. After surgery, creatinine and BUN decreased in both the sevoflurane and isoflurane groups without significant differences between groups. The incidence of post-operative proteinuria was similar in the sevoflurane and isoflurane groups. We conclude that hemodynamic stability in patients with hypertension and ischemic heart disease is similar with sevoflurane and isoflurane. No differences in renal function were observed between the sevoflurane and isoflurane groups.
在无明显心血管疾病的患者中，七氟烷和异氟烷的血流动力学效应相似；然而，七氟烷在高血压和缺血性心脏病患者中的血流动力学效应尚不清楚。为了研究在这一高危人群中七氟烷与异氟烷相比的效应，214例计划接受择期手术的患者入组，前提是他们有缺血性心脏病证据或存在缺血性心脏病的多个危险因素。患者被随机分配接受七氟烷（n = 106）或异氟烷（n = 108）进行麻醉维持，同时联合使用芬太尼和氧化亚氮-氧气混合气。在调整挥发性麻醉药浓度后，动脉血压或心率较诱导前值偏差超过20%且持续存在时，根据需要使用静脉注射去氧肾上腺素、麻黄碱、硝酸甘油、阿托品或艾司洛尔进行治疗。在手术前、手术后即刻以及术后24小时和48小时测量肌酐、血尿素氮（BUN）和尿蛋白。为了进行分析，将患者分为诊断为慢性高血压和未诊断为慢性高血压的两组。有或无慢性高血压的患者对七氟烷和异氟烷的心率和动脉血压反应无差异。两种麻醉药与血流动力学偏差的更频繁治疗均无关联。手术后，七氟烷组和异氟烷组的肌酐和BUN均下降，两组间无显著差异。七氟烷组和异氟烷组术后蛋白尿的发生率相似。我们得出结论，高血压和缺血性心脏病患者使用七氟烷和异氟烷时血流动力学稳定性相似。七氟烷组和异氟烷组之间未观察到肾功能差异。
