Comparison Of The Effect Of Sevoflurane, Isoflurane And Propofol On Myocardial Injury During Perioperation In Elderly Hypertensive Patients

Objective To compare the effects of sevoflurane ,isoflurane and propofol on myocardial injury during perioperation in elderly hypertensive patients.Methods Thirty-six elderly hypertensive patients were randomly divided into three groups of 12 patients each.: sevoflurane group; isoflurane group; propofol group. Anesthesia was performed with sevoflurane,isoflurane or propofol plus sufentanyl. The changes of ST-segment was recorded before general anesthesia(TⅠ), after intubation(TⅡ),exploration(TⅢ) and extubation(TⅣ). Vein blood samples were collected before general anesthesia(T0),1h after incision(T1), end of the operation(T2), 3h(T3),6h(T4) ,12h(T5) and 24h(T6) postoperative. Plasma concentrations of troponin I (cTnI), creatine kinase-MB(CK-MB), interleakin-6(IL-6), c-reactive protein(CRP) and solube intercellular adhesion molecule-1(sICAM-1) were determined respectively.Results The ST-segment depressed significantly from TⅡto TⅣin three groups(P<0.05), and at TⅣ, the ST-segment in propofol group was significantly lower than those in isoflurane and sevoflurane group(P<0.05). Plasma concentration of cTnI began rising at T1(P<0.05), and then reached to peak at T4 in three groups. cTnI at T3～T6 in propofol group were signiflcantly higher than those in isoflurane and sevoflurane group(P<0.05). Plasma concentration of CK-MB began rising at T2 in three groups (P < 0.05),and without difference between groups. Plasma concentration of IL-6 began increasing at T1 (P<0.05), and then reached to peak at T3 or T4 in three groups. IL-6 at T6 in propofol group was significantly lower than those in isoflurane and sevoflurane group(P<0.05). Plasma concentration of CRP began increasing at T4 in three groups(P<0.05). CRP at T6 in propofol group was significantly higher than those in isoflurane and sevoflurane group(P<0.05). Plasma concentation of sICAM-1 began increasing at T2(P<0.05), and then reached to peak at T4～T5 in three groups. sICAM-1 at T4～T6 in sevoflurane groups was significantly lower than those in propofol group(P<0.05), and at T6 in isoflurane group was significantly lower than those in propofol group(P<0.05).Conclusions Eiderly hypertensive patients had suffered some degrees of myocardial injury during perioperative. When anesthesia was performed with sevoflurane, isoflurane or propofol in elderly hypertensive patients, sevoflurane and isoflurane have better effect on lessening perioperative myocardial injury than propofol, and sevoflurane maybe have some more contribution on myocardial injury than isoflurane.