摘要
目的比较术中硬膜外复合全身麻醉行气管插管或应用喉罩,全凭静脉麻醉或吸入麻醉复合瑞芬太尼靶控输注对术中应激反应的影响。方法选择北京大学第一医院外科60例年龄18～65岁,美国麻醉学会(ASA)Ⅰ～Ⅱ级;择期胃肠、胆囊、肾手术患者,随机分为硬膜外复合全麻气管插管组(EG 组)、喉罩组(EGL 组)、瑞芬太尼复合丙泊酚全凭静脉麻醉组(RP 组)、瑞芬太尼复合吸入麻醉组(RI 组)各15例;术中连续监测血压、心电图、脉搏氧饱和度;呼气末二氧化碳分压;术前、诱导后、切皮后、术毕取血测血浆肾上腺素和去甲肾上腺素、血管紧张素Ⅰ和血管紧张素Ⅱ、胰高糖素和血糖。结果诱导时 RP 组血压低于 EG 组和 EGL 组,气管插管时 EG 组血压、心率高于 EGL 组及RP 组(P<0.05),手术切皮时心率变化最小为 RP 组,拔管时 EGL 组心率最快。各组肾上腺素与去甲肾上腺素在诱导和插管时都有轻度下降而在手术结束时都有上升。RP 组术毕时去甲肾上腺素比其他时间点升高,差异有统计学意义(P<0.05)。胰高糖素在诱导插管时轻微下降,术毕降到最低,RP 组术毕时胰高糖素显著降低。血糖在诱导和插管时轻度下降,术毕时4个组血糖均显著性升高。EG 组和 EGL 组术毕胰高血糖素、血糖显著高于 RP 组(P<0.05)。结论不同的麻醉方法和药物都能维持术中血流动力学稳定,但均不能完全阻断伤害性刺激的上行传导,应激反应对血流动力学变化和血浆激素水平的影响不是完全平行的。
Objective To investigate the effect of four different anesthetic methods （combined epidural with general anesthesia with endotracheal intubation or with laryngeal mask airway, total intravenous anesthesia or remifentanil intravenous infusion combined with inhalational anesthesia） on stress reaction in patients undergoing upper abdominal surgery. Methods Sixty ASA Ⅰ -Ⅱ patients, aged 18-65y, scheduled for elective upper abdominal surgery were enrolled in the study. They were divided into four groups： epidural combine general anesthesia with intubation group （EG group） and with laryngeal mask group （EGL group）, total intravenous remifentanil combined with propofol （ RP group） and inhalational group （ RI group）. Blood pressure, ECG, SpO2, PETCO2 were monitored continuously. Level of epinephrine and norepinaphrine, angiotensin Ⅰ and angiotensin Ⅱ, glicentin and blood glucose in blood plasma were measured before operation, after induction, after skin incision and at the end of operation. Results The Blood pressure in RP and RI groups was lower than that in EG and EGL groups at induction. Blood pressure and heart rate of EG group were higher than those in RP, RI and EGL groups during intubation. Heart rate of RP group changed least than the other groups at skin incision. Heart rate of EGL group was higher than that in the other groups at extubation. Epinephrine and norepinaphrine were lowered slightly at intubation and skin incision, and were raised at the end of operation in all groups. Norepinaphrine of RP group increased distinctly compared with preoperative level. Glicentin was decreased slightly at intubation in all groups, and dropped to the lowest at the end of operation, glicentin in RP group was decreased significantly compared with preoperative level. Blood glucose was lowered slightly at induction and intubation, and was raised distinctly at the end of operation in four groups. Glucagon and Blood glucose of RP and RI groups were lower than those of EG and EGL groups. Conclusion Different anesthetic methods and anesthetic drugs had different effects on stress reaction （hormones） during surgical operation. Regardless of general anesthesia or intrathecal anesthesia, harmful stimulus could not be completely blocked by the intraoperative management and stress regulation during operation. Intrathecal anesthesia combined with general anesthesia could inhibit the stress reaction during upper abdominal surgery. Continuous remifentanil target controlled infusion could inhibit the degree of stress reaction, either.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2007年第15期1025-1029,共5页
National Medical Journal of China
关键词
麻醉药
吸入
麻醉
静脉内
麻醉
硬膜外
喉面罩
应激
Anesthetics, inhalation
Anesthesia, intravenous
Anesthesia epidural
Larygeal masks
Stress
