血浆靶浓度控制输注全凭静脉麻醉联合硬膜外阻滞对上腹部手术患者应激反应的影响  

Effects of Total Intravenous Anesthesia(TIVA)with Controlled Plasma Concentrations of Anesthetics and TIVA Combined with Epidural Anesthesia on the Stress Reaction in Patients Undergoing Major Epigaetric Operations

作　　者：严美娟[1] 楼小侃[1] 

机构地区：[1]浙江省人民医院麻醉科,杭州310014

出　　处：《医药导报》2006年第4期295-298,共4页Herald of Medicine

摘　　要：目的观察舒芬太尼、异丙酚、维库溴铵血浆浓度控制输注全凭静脉麻醉(TIVA)或联合硬膜外阻滞(EIVA)对上腹部手术血糖、血浆肾上腺素、血清皮质醇的影响。方法择期上腹部手术患者40例,ASAⅠ或Ⅱ级,随机分成TIVA组和EIVA组各20例,TIVA组通过血浆靶浓度控制输注舒芬太尼、异丙酚、维库溴铵进行全凭静脉麻醉;EIVA组在TIVA组的基础上联合0.375%罗哌卡因硬膜外阻滞。于麻醉前(t0)、气管插管后2 m in(t1)、切皮后2 m in(t2)、腹腔探查时(t3)、切皮后1.0 h(t4)及拔管后2 m in(t5)采血检测血浆肾上腺素、血清皮质醇和血糖浓度。结果t4、t5时两组血糖均高于t0(P<0.05),TIVA组升高较EIVA组明显(P<0.05)。EIVA组血清皮质醇浓度t3时低于t0(P<0.05),t5回复t0水平;TIVA组则于t4和t5时高于t0(P<0.05),且高于EIVA组(P<0.05)。两组血浆肾上腺素均于t2低于t0(P<0.05),t3、t4回复至t0水平;TIVA组t5时高于t0(P<0.05);TIVA组t3和t5时高于EIVA组(P<0.05)。结论异丙酚、舒芬太尼、维库溴铵血浆浓度控制输注静脉麻醉或联合硬膜外阻滞行上腹部手术对血浆肾上腺素和血清皮质醇都有明显的抑制作用;联合硬膜外阻滞时血浆肾上腺素和血清皮质醇抑制作用更明显,降低高血糖反应的程度,能明显缓解围术期的机体应激反应。Objective To study the effects of total intravenous anesthesia （TIVA） with controlled plasma concentrations of propofol , sufentanil and vecuronium bromide as well as TIVA combined with epidural anesthesia on the plasma levels of glucose, epinephrine and cortisol in patients undergoing major epigaetric operations. Methods 40 patient of ASA grade Ⅰ or Ⅱ scheduled for epigaetric operations were randomly divided into 2 equal groups： group TIVA ad group EIVA. Patients of the group TIVA were subjected to total intravenous anesthesia with targeted plasma concentrations of propofol, sufentaniI and vecuronium bromide. On the basis of the TIVA, patients of the group EIVA were given each a sustained epidural injection of 0.375 % ropivacaine at a speed of 5 mL · h^-1. Arterial blood samples were collected at the time before anesthesia （ to ）, 2 min after endotraeheal intubation（ t1 ） ,2 rain after skin incision（ t2 ）, during exploration of the peritoneal cavity（ t3 ）, 1.0 h after skin incision（t4） and 2 rain after extubation （t5） for the determination of plasma levels of glucose, epinephrine and cortisoI. Results Blood glucose levels at t4 and t5 in patients of both groups were higher than those at to（P 〈0.05）. However, patients of group TIVA had higher blood glucose levels at these time points than those in patients of group EIVA （ P 〈 0.05 ）. Plasma concentrations of cortisol in patients of group EIVA were lower at t3 than those at to （ P 〈 0. 05） and they return to the to level at t5. Plasma concentrations of cortisol in patients of group TIVA were higher at t4 and ts than those at to （ P 〈 0.05 ） and they were also higher than those in patients of group EIVA（ P 〈 0.05 ）. Plasma concentrations of epinephrine in patients of both groups were lower at t2 than those at to （P 〈 0.05）, and there were restored to to levels at t3 and t4. Plasma concentrations of epinephrine in patients of group TIVA were higher at tsthan those at to （ P 〈 0.05）. Plasma

关 键 词：上腹部手术 全身麻醉 靶控输注 硬膜外阻滞 应激反应 

分 类 号：R971.2[医药卫生—药品] R614[医药卫生—药学]