机器人辅助腹腔镜前列腺切除术中不同全麻药对心室复极的影响

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Effect of different general anaesthetics on ventricular repolarisation in robot-assisted laparoscopic prostatectomy

背景与目的

不同类型的麻醉药物对心室复极可产生不同的影响。本研究旨在比较不同种类全麻药物在机器人辅助腹腔镜根治性前列腺切除术(RALP)中对心室复极的影响。

方  法

69例患者随机分为七氟醚组(七氟醚/瑞芬太尼)、地氟醚组(地氟醚/瑞芬太尼)和全凭静脉麻醉组(丙泊酚/瑞芬太尼)，但只有67例患者完成研究。主要结果是在RALP期间的9个时间点收集的心率校正QT(QTc)间期。QT间期校正采用Bazett公式(QTcB)和Fridericia公式(QTcF)。次要结果为在同一时间点采集的Tpeak-Tend间期(Tp-e)和Tp-e/QT比值。

结 果  

术中各组的QTcB和QTcF间期均明显延长，但随着时间推移，这些值表现出明显的组间差异。采用头低脚高位后，地氟醚组QTcB和QTcF间期明显长于其他两组，并持续到手术结束。术中地氟醚组有6例患者QTcB间期和5例患者QTcF间期分别超过450ms，而TIVA组无一例出现QTcB和QTcF间期超过450ms。而且，术中地氟醚组QTc间期延长>20ms和>60ms的发生率明显高于TIVA组。术中三组Tp-e间期和Tp-e/QT比值无显著差异。

结 论

为了最大限度减少RALP期间QTc间期延长，建议采用丙泊酚/瑞芬太尼全凭静脉麻醉。

原始文献来源及摘要

Park JH, Lee KY, Choi YD, et al. Effect of different general anaesthetics on ventricular repolarisation in robot-assisted laparoscopic prostatectomy.[J].Acta Anaesthesiol Scand 2020 Jun 12,10.1111/aas.13653.

Abstract

Background:Ventricular repolarisation is affected differently by the types of anaesthetics used. This study aimed to compare the effect of different types of anaesthetics on ventricular repolarisation during robot-assisted laparoscopic radical prostatectomy (RALP).

Methods:Sixty-nine patients were randomly assigned in a 1:1:1 ratio to the Sevoflurane (sevoflurane/remifentanil), Desflurane (desflurane/remifentanil) or total intravenous anaesthesia (TIVA [propofol/remifentanil]) groups; however, only 67 patients completed the study. The primary outcome was heart rate-corrected QT (QTc) interval collected at nine time points during RALP. Bazett's (QTcB) and Fridericia's (QTcF) formulae were used for QT interval correction. The secondary outcomes were Tpeak-Tend (Tp-e) interval and Tp-e/QT ratio that were collected at the same time points.

Results: The QTcB and QTcF intervals were significantly prolonged during surgery in all groups; however, these values showed significant intergroup differences with time. After assuming the Trendelenburg position, the QTcB and QTcF intervals were significantly longer in the Desflurane group than in the other two groups, and this prolongation continued until the end of surgery. Intra-operatively, the QTcB and QTcF intervals exceeded 450 ms in six and five patients, respectively, in the Desflurane group, but in none in the TIVA group. Moreover, the incidence of intra-operative QTc interval prolongation >20 ms and >60 ms was significantly higher in the Desflurane group than in the TIVA group. There were no significant differences in Tp-e intervals and Tp-e/QT ratio among the three groups during surgery.

Conclusions: To minimise QTc interval prolongation during RALP, TIVA with propofol/remifentanil is recommended for general anaesthesia.

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文中所涉及药物使用、疾病诊疗等内容仅供参考。

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