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【摘要】 目的 比较不同麻醉用药与不同麻醉方法对术中应激反应的影响。方法 选60例年龄18~65岁,性别、身高、体重比较均无显著性差异,ASA分类Ⅰ-Ⅱ级,择期胃肠,胆囊,肾手术病例,分为硬膜外加全麻气管插管组(EG组)或喉罩组(EGL组)、瑞芬太尼加吸入麻醉组(RI组)、瑞芬太尼+异丙酚全静脉麻醉(RP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;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 不同麻醉用药与不同麻醉方法在各时间点内激素水平不相同,不同麻醉用药与不同麻醉方法时血压心率变化也存在很大差异。结论 在术中不同麻醉用药与不同麻醉方法会导致不同的应激反应。
【关键词】 麻醉用药;麻醉方法;应激反应
Of different anesthetic agents with different anesthesia methods on intraoperative stress response
ZHOU Ji-Zi,ZHANG Xiao-li.
Xin Sichuan China and the United States Medical Beauty Hospital ,Chendu 610071,China
【Abstract】 Objective Comparison of different anesthetic aEGnts with different anesthesia on intraoperative stress response.Methods Selected 60 cases of aEG 18-65 years old,each group sex,height,weight,compared no significant difference in,ASA classification Ⅰ-Ⅱ level,elective gastrointestinal,gallbladder,nephron sparing surEGry cases was divided into epidural anesthesia plus intubation group (EG group) or larynEGal mask airway group (EGL group),remifentanil plus inhalation anesthesia group (RI group),remifentanil+propofol total intravenous anesthesia (RP group) of the 15 cases,intraoperative continuous monitoring of blood pressure,electrocardiogram,pulse oxyEGn saturation; end-tidal carbon dioxide; Preoperative,induction,after incision,intraoperative completion of blood sampling to measure plasma epinephrine and norepinephrine,angiotensinⅠand angiotensin Ⅱ,glucagon and blood glucose.Results Of different anesthetic aEGnts with different anesthesia methods at all time points within the hormone level was not the same,different anesthetic aEGnts with different anesthesia methods of blood pressure and heart rate chanEGs had also varied greatly.Conclusion During the operation of different anesthetic aEGnts with different anesthesia methods will lead to different stress response.
【Key words】 Anesthetic drugs;Anesthesia;Stress response
作者单位:610071四川华美紫馨医学美容医院(周激);成都市第九人民医院(张小丽)
1 资料与方法
1.1 一般资料 选60例年龄18~65岁,性别、身高、体重比较均无显著性差异,ASA分类Ⅰ-Ⅱ级,择期胃肠,胆囊,肾手术病例,分为硬膜外加全麻气管插管组(EG组)或喉罩组(EGL组)、瑞芬太尼加吸入麻醉组(RI组)、瑞芬太尼+异丙酚全静脉麻醉(RP组)各15例。
1.2 方法 术中连续监测血压、心电图、脉搏氧饱和度;呼气末二氧化碳;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。
1.3 统计学分析 各计量指标用(x±s)表示。对组间方差齐,各组变量呈正态分布,符合方差分析条件,采用单因素方差分析进行组间比较,对各时间点指标进行组内比较。方差不齐,采用非参数K11lscall-wallis秩和检验。对总的比较差异有统计学意义(P RI组151431±7472082±1416c2118±12902030±1371
RP组15976±791803±6571201±12301088±1078
表3
4组患者各时间点内血管紧张素Ⅱ�浓度变化(x±s,pg/ml)
组别例数术前诱导后切皮后术毕
EG组1527±1628±1828±2023±19
EGL组1535±1030±1232±1428±8
RI组1536±1539±1241±638±14
RP组1531±2220±1743±3534±12
表4
4组患者各时间点内胰高糖素浓度变化(x±s,pg/ml)
组别例数术前诱导后切皮后术毕
EG组15156±83150±49133±62140±46d
EGL组15191±72182±71165±34157±57d
RI组15185±115176±56202±52130±42
RP组15150±88131±47b145±78b85±32b
表5
4组患者各时间点内血糖浓度变化(x±s,mmol/ml)
组别例数术前诱导后切皮后术毕
EG组156.4±0.85.6±0.86.1±1.48.1±1.3de�
EGL组156.6±1.05.8±0.65.8±0.79.3±1.7de�
RI组156.4±0.86.0±0.95.8±0.87.7±1.7e
RP组156.0±0.75.3±0.45.2±0.86.3±1.3e
注:与EG组及RP组比较,aP
