关键词: 老年, 冠心病, 非心脏手术, 七氟醚, 心肌缺血, 心肌保护

Abstract: Objective To evaluate the myocardial protective effects of sevoflurane in elderly patients with coronary heart disease (CHD) undergoing non-cardiac surgery. Methods It was a multicenter prospective randomized evaluator-blinded controlled clinical study, including 165 ASAⅡ~Ⅲ elderly patients with CHD undergoing elective major noncardiac surgery in 4 medical centers in China. Anesthesia was maintained with sevoflurane-air-O2 ( Group S, n=83) or propofol （Group P, n=82）. Blood pressure, HR, and 12-lead ECG were recorded at baseline, during the surgery, immediately after the surgery, and on post-operative day 1 and day 2. ECG ST-T segment abnormalities was analyzed. Patients were followed up 30 days after surgery to record cardiac adverse events (including unstable angina, myocardial infarction, congestive heart failure and cardiac death). Results The incidence of new occurring myocardial ischemia observed by 12-lead ECG for group S was significantly lower on postoperative day 1 (16.9% VS 30.5%, P<0.05) and postoperative day 2 (12.0% VS 31.7%, P<0.05) compared with group P. Conclusions Sevoflurane could reduce the occurrence of postoperative myocardial ischemia for elderly patients with CHD undergoing non-cardiac surgery. However, it did not change the cardiac outcomes in terms of perioperative cardiac adverse events and mortality.

Key words: elderly patients, coronary heart disease, noncardiac surgery, sevoflurane, myocardial ischemia, myocardial protection