肾移植术中异丙酚患者自控镇静时血栓素A_2和前列环素的变化  

The changes of TXA_2 and PGI_2 levels in renal transplantation patients using patient-controlled sedation with propofol

作　　者：陈菲 柳朴[2] 

机构地区：[1]云南省昆明法医院麻醉科,650034 [2]广东省东莞市太平人民医院同位素科,523900

出　　处：《河北医药》2005年第5期333-335,共3页Hebei Medical Journal

摘　　要：目的观察硬膜外麻醉下,肾移植术中异丙酚患者自控镇静(PCS)时的心率、血压、中心静脉压,血栓素A2(TXA2)和前列环素(PGI2)的变化,探讨患者内环境的改变.方法 ASA Ⅲ级,终末期肾衰患者50例,随机分为对照组和PCS组,每组25例.观察硬膜外麻醉后手术前(T0)、切皮(T1)、放三叶拉钩(T2)、移植肾血管开放后膀胱充水(T3)、缝切口(T4)、缝皮(T5)6个时点的心率、血压、中心静脉压变化,并在6个时点采血测血栓素B2(TXB2)和6-酮-前列腺素F1α(6-keto-PGF1α)水平.结果 (1)PCS组的舒张压下降在T0～T2低于对照组;(2)对照组的6-keto-PGF1α升高在T3、T4、T5时差异非常显著(P＜0.01).结论异丙酚PCS镇静用于硬膜外麻醉下肾移植时对PGI2生成有一定的抑制作用,术中患者舒张压下降.Objective To investigate the effect of patient-controlled sedation (PCS) with propofol on the levels of HR,SBP,DBP,CVP,TXA_2 and PGI_2 in renal transplantation patients under epidural anesthesia.Methods 50 patients with ASA Ⅲ and end-stage renal failure were randomly divided into the PCS group and control group,25 cases in each group.After epidural anesthesia, the changes of HR,SBP,DBP,CVP,TXB_2 and 6-keto-PGF_ 1α levels were observed at 6 time points:the time after epidural anesthesia and before surgery (T_0),skin incising (T_1),placing tri-wing tractor (T_2),bladder infusing with urine after opening vascular anastrmosis (T_3),incision suturing (T_4),skin closing (T_5).Results (1) The levels of diastolic blood pressure in the PCS group obviously decreased,as compared with those of control group during T_0～T_2;(2)In control group,6-keto-PGF_ 1α content of blood plasma increased remarkably at the points of T_3 T_4 T_5 ( P <0.01).Conclusion PCS with propofol in renal transplantation patients under epidural anesthesia can inhibit the synthesis of PGI_2 and reduce the levels of diastolic blood pressure.

关 键 词：肾移植 异丙酚 自控镇静 血栓素A2 前列环素 

分 类 号：R699.2[医药卫生—泌尿科学]