【罂粟摘要】使用灌注指数比较地氟醚和七氟醚的血管舒张特性:一项随机对照试验
使用灌注指数比较地氟醚和七氟醚的血管舒张特性:一项随机对照试验
根据光电容积脉搏波描记法波形计算的灌注指数(PI)反映的外周血管舒缩张力，因此，PI可替代药物诱导引起的血管收缩或舒张的定量测量。本研究旨在比较，在接受单一吸入麻醉的患者中，吸入相等浓度地氟烷和七氟烷对患者PI的影响，其中，等浓度吸入麻醉剂是根据已知两种吸入麻醉药物的最低肺泡浓度所确定。
将择期膝关节镜手术的患者进行随机分配，靶控输注丙泊酚诱导麻醉后，接受地氟烷或七氟烷进行全身麻醉；神经肌肉阻滞(罗库溴铵)后，浓度维持在经年龄校正的最低肺泡浓度1.0。在麻醉诱导后以及标准化伤害性刺激后，记录每分PI和血流动力学数据，持续35分钟。主要结果是观察PI，比较不同时间两组之间差异(重复测量方差分析)，次要观察指标为MAP和HR。
纳入69名受试者(平均年龄：42岁[19-65岁]；49%的女性)被分配到地氟烷组(n=34)或七氟烷组(n=35)；与七氟烷相比，七氟烷组的PI仍高于七氟烷组(P<0.0 5)，在强直刺激前(平均差值为3.3%，95%可信区间为2.0~4.7；P<0.001)，强直刺激后(平均差值为2.8；95%可信区间为2.0~3.7；P<0.001)。伤害性刺激前（MD：8mmHg；95%CI：4-12)，伤害性刺激后(MD：14mmHg；95%CI：7-22)，地氟烷组受试者表现为PI升高及MAP降低(P<0.001),HR相似。
研究结果表明，在同等剂量下，地氟烷具有更强的血管扩张特性，并能降低血压，降低幅度可能与伤害性刺激有关。
Comparison of vasodilatory properties between desflurane and sevoflurane using perfusion index: a randomised controlled trial
Abstract
Background: The perfusion index (PI), calculated from the photoplethysmographic waveform, reflects peripheral vasomotor tone. As such, the PI serves as a surrogate for quantitative measures of drug-induced vasoconstriction or vasodilation. This study aimed to compare the effect on the PI of desflurane and sevoflurane at equi-anaesthetic concentrations in patients undergoing single-agent inhalation anaesthesia, where equi-anaesthetic dose was based on the known minimum alveolar concentration of these agents.
Methods: We randomly allocated patients scheduled for arthroscopic knee surgery to receive either desflurane or sevoflurane general anaesthesia after target-controlled induction of anaesthesia with propofol. Anaesthesia was maintained at age-corrected minimum alveolar concentration 1.0, under neuromuscular block (rocuronium). The PI and haemodynamic data were recorded every minute for 35 min after induction of anaesthesia and after standardised nociceptive stimulation. The primary outcome was PI, compared between the groups over time (repeated-measures analysis of variance). Secondary outcomes included MAP and HR.
Results: Sixty-nine participants (mean [range] age: 42 yr [19e65 yr]; 49% females) were assigned to either desflurane difference [MD]: 3.3; 95% confidence intervals [CIs]: 2.0e4.7; P<0.001) and after tetanic stimulation (MD: 2.8; 95% CI:(n=34) or sevoflurane (n=35). The PI remained higher under desflurane compared with sevoflurane, both before (mean2.0-3.7; P<0.001). Higher PI paralleled lower MAP in participants assigned to desflurane anaesthesia (P<0.001), both before(MD: 8 mm Hg; 95% CI: 4-12) and after nociceptive stimulation (MD: 14 mm Hg; 95% CI: 7-22). HR was similar throughout.
Conclusions: These findings suggest that at equipotent doses, desflurane exerts more potent vasodilatory properties and lowers blood pressure by a magnitude potentially associated with harm.Clinical trial registration: NCT03570164.
翻译：吴学艳
编辑：佟睿
审核：曹莹