摘要
目的 比较七氟烷- 舒芬太尼静吸复合麻醉与丙泊酚- 舒芬太尼全凭静脉麻醉两种麻醉方式对妇科腹腔镜手术患者血流动力学及应激反应的影响,为临床用药提供参考.方法 选择40 例需行妇科腹腔镜手术的患者,随机分为七氟烷组（S 组,n = 20）和丙泊酚组（P 组,n = 20）.同样的麻醉方法诱导,且术中均持续泵注舒芬太尼[0.2μg/（kg·h）] 维持镇痛.S 组气管插管后吸入七氟烷维持麻醉（1% ～ 3%）,P 组静脉输注丙泊酚[2 ～ 4 mL/（kg·h）] 维持麻醉.记录麻醉诱导前5 min（T0）、气腹后5 min（T1）、气腹后30 min（T2）、术毕拔管时（T3）的心率、血压、SpO2,并分别于这4 个时间点采集外周静脉血检测血管紧张素Ⅱ（AT- Ⅱ）、皮质醇（COS）及血糖浓度.结果 组内比较S 组患者术中血浆AT- Ⅱ、COS 浓度在T1、T2、T3 时间点分别与T0 比较,差别均有统计学意义（P 〈 0.05）,血糖浓度在T2、T3 时间点分别与T0 比较,差别有统计学意义（P〈 0.05）;P 组患者术中血浆AT- Ⅱ、COS 及血糖的浓度在T1、T2、T3 分别与T0 比较,差别均有统计学意义（P 〈 0.05）.组间比较：在T0 时间点,两组患者血浆AT- Ⅱ、COS 及血糖的表达水平差异均无统计学意义（P 〉 0.05）;在T1、T2、T3 时间点两组患者血浆AT- Ⅱ、COS 及血糖浓度组间比较差别均有统计学意义（P 〈 0.05）.两组患者在T0 ～ T3 时间点的HR、SBP、DBP 组间比较差别均无统计学意义.结论 七氟烷- 舒芬太尼静吸复合麻醉及丙泊酚- 舒芬太尼全凭静脉麻醉都能较好地维持妇科腹腔镜手术中的麻醉深度及血流动力学稳态,但与丙泊酚相比,七氟烷可更好地抑制患者术中应激反应.
Objective To search the effect of different anesthetics to prevent stress response induce by pneumoperitoneum during laparoscopic. Byobserving the changes of patients in the hemodynamics and the stress hormone levels, to desire may provide the theoretical basis for laparoscopic surgery andthe choice of drugs. Methods 40 female patients were randomly divided into two groups Group Sevoflurane（ Group S, n = 20） and Group Propofol（ Group 0P,n = 20）. All patients were anesthetized with the same anesthetics. Group S were received 1 ～ 3% of sevofluraneinhalationand 0.2 μg·kg-1 of intravenousinfusion of sufentanil during operation. Group 0P were received 2 ～ 4 mg·kg-1 propofol and 0.2 μg·kg-1 of sufentanil during operation. Systolic bloodpressure, diastolic blood pressure and heart rate were recorded at the time of 5 min before anesthetic induction（ T0）, 5 min after Pneumoperitonum（ T1）, 30min after pneumoperitonum（T2） and after operation（ T3）. Meanwhile, blood samples were obtained from the patients to determine the blood angiotensin Ⅱ（AT- Ⅱ）, cortisol（ COS） and blood glucose concentrations.Results The comparison of the two groups in the concentrations of plasma AT- Ⅱ and COS ateach time point ： within group S, all have statistical differences in the concentrations of plasma AT- Ⅱ and COS at T1, T2, T3 compared with T0, and havestatistical differences in the concentrations of blood glucose at T0 compared with T2, T3（ P 〈 0.05）; within group 0P, all have statistical differences of AT-Ⅱ, COS and blood glucose concentrations at T1, T2, T3 compared with T0（ P 〈 0.05）; between the two groups： at T0 time point： there were no statisticaldifferences between the two groups in the concentrations of plasma AT- Ⅱ, COS and blood glucose concetrations（ P 〉 0.05）; at T1 , T2 , T3 time points： therewere statistical differences between the two groups in the concentrations ofplasma AT- Ⅱ, COS and blood glucose（ P 〈 0.5）.Conclusion By adjusting thesevoflurane or propofol dosage, the patient is similar to the depth of sedation, which can achieve stable hemodynamics. Under the same pneumoperitoneum,the effect of sevoflurane is stronger than propofol on inhibition the release of angiotensin Ⅱ, cortisol and blood glucose.
出处
《中国处方药》
2016年第7期10-12,共3页
Journal of China Prescription Drug
关键词
七氟烷
舒芬太尼
腹腔镜
应激反应
Sevoflurane
Propofol
Laparoscopic
Stress response
