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Plos One:七氟醚可进一步增加慢性糖尿病患者QTc间期的延长

2018-03-04 王子君 “罂粟花”微信号

七氟醚可显著延长QTc间期,且慢性糖尿病患者的延长程度明显大于血糖正常的患者。尽管Tp-ec不受七氟醚影响,但应该指出,同时阻断钾离子通道会增加心律失常的风险。

背景与目的

QTc间期延长是糖尿病的严重并发症且增加了患者的死亡率。高血糖抑制了快速延迟整流钾通道电流(Ikr),延长了心电图上的QTc间期。七氟醚同样也抑制了Ikr并导致QTc间期延长。事实上,七氟醚麻醉的糖尿病患者发生的尖端扭转型心动过速难以控制。

方  法

本试验纳入了74例患者,包括37例血糖正常的患者(糖化血红蛋白[HbA1c]:<6.5%)(NG组)和37例慢性糖尿病患者(HbA1c:≥6.5%)(HG组)。采用2mg/kg/丙泊酚和0.3ug/kg/min瑞芬太尼诱导麻醉,2%七氟醚,40%O2和0.2-0.3ug/kg/min瑞芬太尼维持麻醉。吸入七氟醚后5,10,30,60,90,120min时测量QT间期和Tp-e间期(从T波的峰顶到底部),并根据患者的心率校正值(即QTc和Tp-ec)。P<0.05认为有统计学意义。

结  果

吸入七氟醚前两组间的QTc和Tp-ec间期没有显着差异。两组患者在吸入七氟醚后QTc间期随时间延长而增加,且在10min时比基础值明显延长。吸入七氟醚90min和120min时,HG组的QTc间期明显比NG组延长。两组的Tp-ec间期均不受七氟醚的影响。

结  论

七氟醚可显着延长QTc间期,且慢性糖尿病患者的延长程度明显大于血糖正常的患者。尽管Tp-ec不受七氟醚影响,但应该指出,同时阻断钾离子通道会增加心律失常的风险。

原始出处:

Kimura S, Nakao S, Kitaura A, et al. Sevoflurane causes greater QTc interval prolongation in chronically hyperglycemic patients than in normoglycemic patients[J]. Plos One, 2017, 12(12):e0188555.

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    2018-03-04 wqkm

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