丙泊酚与依托咪酯对Brugada综合征患者心电图的影响

丙泊酚与依托咪酯对Brugada综合征患者心电图的影响

翻译：冯玉蓉  编辑：冯玉蓉  审校：曹莹

背景：Brugada综合征是一种遗传性心律失常，以右侧心前区V1~V3导联ST段典型拱形抬高为特征。BrugadaDrugs.org咨询委员会建议Brugada综合征患者避免使用丙泊酚。由于缺乏前瞻性研究，本研究旨在评估丙泊酚和依托咪酯对Brugada综合征患者心电图ST段和QRS波的影响。在本试验中，我们假设在Brugada综合征患者中丙泊酚或依托咪酯大剂量诱导麻醉，在临床上不会影响ST段和QRS波，亦不会诱发心律失常。

方法：本项前瞻性、双盲试验中，98例确诊的Brugada综合征患者随机接受丙泊酚(2 ~ 3mg·kg-1)或依托咪酯(0.2 ~ 0.3mg·kg-1)进行麻醉诱导。主要观察指标是ST段和QRS波的变化，以及麻醉诱导后新型心律失常的发生。

结果：本试验分析了80例患者的数据：43例使用丙泊酚，37例使用依托咪酯。所有患者ST段抬高均不大于或等于0.2 mV，每组均有1例患者ST段抬高0.15 mV。丙泊酚组观察到11次ST降至−0.15mV，依托咪酯组观察到5次。丙泊酚组中有1例患者在诱导后QRS波延长25%，依托咪酯组中有3例。该试验没有发现任何证据表明两组的变化不同，大多数百分位数值为0(中位数[25th, 75th], 0 [0, 0] vs. 0 [0, 0])。最终，两组患者围手术期均未出现新型心律失常。

结论：本试验发现使用丙泊酚或依托咪酯进行麻醉诱导时，Brugada综合征患者的心电图改变似乎并无显著差异。本研究并未探讨丙泊酚输注用于维持麻醉过程中心电图变化，因此在对Brugada综合征患者输注丙泊酚的安全性做出结论之前，需要进一步的研究。

原始文献来源：Flamee P, Varnavas V, Dewals W, et al. Electrocardiographic Effects of Propofol versus Etomidate in Patients with Brugada Syndrome.[J]. Anesthesiology. 2020 Mar;132(3):440-451. doi: 10.1097/ALN.0000000000003030.

Electrocardiographic Effects of Propofol versus Etomidate in Patients with Brugada Syndrome

ABSTRACT

Background: Brugada Syndrome is an inherited arrhythmogenic disease, characterized by the typical coved type ST-segment elevation in the right precordial leads from V1 through V3 . The BrugadaDrugs.org Advisory Board recommends avoiding administration of propofol in patients with Brugada Syndrome. Since prospective studies are lacking, it was the purpose of this study to assess the electrocardiographic effects of propofol and etomidate on the ST- and QRS-segments. In this trial, it was hypothesized that administration of propofol or etomidate in bolus for induction of anesthesia, in patients with Brugada Syndrome, do not clinically affect the ST- and QRS-segments and do not induce arrhythmias.

Methods: In this prospective, double-blinded trial, 98 patients with established Brugada syndrome were randomized to receive propofol (2 to 3mg·kg-1) or etomidate (0.2 to 0.3mg·kg-1) for induction of anesthesia. The primary end-points were the changes of the ST- and QRS-segment, and the occurrence of new arrhythmias upon induction of anesthesia.

Results: The analysis included 80 patients: 43 were administered propofol and 37 etomidate. None of the patients had a ST elevation greater than or equal to 0.2 mV, one in each group had a ST elevation of 0.15 mV. An ST depression up to −0.15mV was observed eleven times with propofol and five with etomidate. A QRS-prolongation of 25% upon induction was seen in one patient with propofol and three with etomidate. This trial failed to establish any evidence to suggest that changes in either group differed, with most percentiles being zero (median [25th, 75th], 0 [0, 0] vs. 0 [0, 0]). Finally, no new arrhythmias occurred perioperatively in both groups.

Conclusions: In this trial, there does not appear to be a significant difference in electrocardiographic changes in patients with Brugada syndrome when propofol versus etomidate were administered for induction of anesthesia. This study did not investigate electrocardiographic changes related to propofol used as an infusion for maintenance of anesthesia, so future studies would be warranted before conclusions about safety of propofol infusions in patients with Brugada syndrome can be determined.

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