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題 名 | Desflurane Inhibits U Wave in Electrocardiogram=Desflurane抑制心電圖的U波 |
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作 者 | 江晨恩; 李介宏; 彭士魁; 羅主斌; 袁淵明; 陸翔寧; | 書刊名 | Acta Cardiologica Sinica |
卷 期 | 21:4 民94.12 |
頁 次 | 頁214-222 |
分類號 | 418.224 |
關鍵詞 | U波; 心電圖; 揮發性麻醉劑; U wave; ECG; Desflurane; Volatile anesthetics; |
語 文 | 英文(English) |
中文摘要 | 背景 揮發性麻醉劑可抑制心臟細胞細胞膜上的各種離子流及細胞內的離子活性,同時也表現出其抗心律不整的藥理作用。然而,在心電圖所有的波型當中,唯有U波從未被研究是否受到此類麻醉劑的影響。本觀察型的臨床研究就是要探討,在婦科病患的麻醉過程當中,desflurane對U波的影響。方法 在24位健康的婦科病患(美國麻醉醫學會分類的第一級),於麻醉過程當中記錄並分析其第二導程的心電圖。麻醉誘導的方式採用常規的藥物,包括thiopental,fentanyl,succinylcholine三種藥物。麻醉維持期則以desflurane(1至1.5最小肺泡濃度)及氧氣為主。U波幅度的大小是從放大的心電圖記錄紙以手工目視量取。結果 在24位呈現U波的婦科病患當中,其平均幅度為64±24μV。當進行氣管插管的動作時,若病患的心跳因此而有明顯的增快,U波的幅度可以隨心跳變快而增大3倍左右。若病患此時出現短暫的心室性早期收縮,U波的幅度也會變大,是麻醉前的285%±58%。在24位病患當中,desflurane(1至1.5最小肺泡濃度)會顯著且可逆地抑制U波幅度的大小(減少60±24μV,p<0.05)。結論 心電圖的U波會受到desflurane的抑制,可能是與其抑制心臟細胞膜的離子流、細胞內的鈣離子活性及延遲性後去極化有關。本研究結果顯示,U波的生成可能與後膜電位的假說較有關聯。 |
英文摘要 | Background: Volatile anesthetics inhibit cardiac transmembrane ionic currents and intracellular ionic activity and exert antiarrhythmic actions. Among electrocardiogram (ECG) waveforms, the effect of volatile anesthetics on U wave has never been studied. The aim of the present observational study was to evaluate the possible effect of desflurane on U wave in anesthetized patients. Methods: Pen-operative ECG tracings (lead Ⅱ) were recorded and analyzed from 24 gynecologic patients (American Society of Anesthesiologists (ASA), class 1). Anesthesia was routinely induced with thiopental, fentanyl and succinylcholine and maintained with desflurane (1 to 1.5 minimal alveolar concentration (MAC)) and O2. U wave amplitude (U(subscript amp) was manually measured from amplified ECG records. Results: Discernible U wave in 24 patients varied in amplitude (64±24μV). U wave was three times larger when heart rate increased to maximum during tracheal intubation. Similarly, U(subscript amp) was augmented (285%±58% of the control) in extrasystolic beats elicited by tracheal intubation. Desflurane (1 to 1.5 MAC) significantly and reversibly suppressed U(subscript amp)(a decrease by 60±24μV, n=24, p<0.05). Conclusions: The suppressive effect of desflurane on U(subscript amp) might be explained by its inhibitory effects on transmembrane ionic currents, intracellular calcium load and delayed afterdepolarizations. Our results support a contributory role of afterpotentials in the genesis of U wave. |
本系統中英文摘要資訊取自各篇刊載內容。