静吸复合麻醉与全凭静脉麻醉对围手术期应激反应的影响  

Comparative analysis of balanced anesthesia and total intravenous anesthesia on stress response during peri-operation period

作　　者：承耀中[1] 孙莉[1] 李玄英[1] 齐军[1] 

机构地区：[1]中国医学科学院中国协和医科大学肿瘤医院,北京100021

出　　处：《山东医药》2009年第40期8-10,共3页Shandong Medical Journal

摘　　要：目的比较静吸复合麻醉与全凭静脉麻醉对围手术期应激反应的影响。方法40例择期行胃癌根治术的患者随机分为静吸复合麻醉组(BAL组)和全凭静脉麻醉组(TIV组)。分别在麻醉诱导前、手术切皮5 min时、切皮后1 h、切皮后2 h、术后第1天测定血清IL-6、肾上腺素(ADR)、去甲肾上腺素(NADR)的浓度和血压、心率。结果与麻醉诱导前相比,两组患者手术中血清IL-6浓度无明显变化,而术后第1天血清IL-6浓度均增高(P<0.05)。BAL组手术中和术后第1天血清ADR、NADR浓度升高,而TIV组切皮后2 h的血清ADR浓度降低,切皮5min时的血清NADR浓度降低(P均<0.05)。与BAL组相比,TIV组手术中血清ADR浓度和NADR浓度降低,切皮5 min时的心率降低(P均<0.05)。结论全凭静脉麻醉较静吸复合麻醉能够更有效地减轻胃癌根治术患者围手术期血清ADR、NADR浓度的升高,从而更有效地降低围手术期的应激反应。Objective To compare the effects of balanced anesthesia and total intravenous anesthesia on neuroendo- crine and immune responses to surgical stress. Methods Forty patients who underwent elective gastric cancer radical resection were randomly divided into balanced anesthesia group （group BAL） and total intravenous anesthesia group （group TIV）. The serum concentrations of IL-6, adrenalin （ADR） and noradrenalin （NADR） were measured respectively before anesthesia induction, 5 min after incision, 1 h after incision, 2 h after incision and on the first day after operation. Results Serum IL-6 concentration increased significantly on the first day after operation as compared to the time before anesthesia induction in both groups （ P 〈 0.05 ）. Serum ADR and NADR increased significantly in group BAL during and after the op- eration （ P 〈 0.05 ）. In group TIV, ADR decreased significantly 2 h after incision and increased on the first day after operation, and NADR decreased 5 min after incision （P 〈 0. 05）. Serum ADR and NADR decreased significantly in group TIV than in group BAL at 5 min, 1h and 2 h after incision （P 〈 0.05） . The heart rate in group TIV at 5 min after incision was depressed than in group BAL （P 〈 0.05）. Conclusions The total intravenous anesthesia can reduce the stress response during peri-operation period effectively than the balanced anesthesia.

关 键 词：全凭静脉麻醉 静吸复合麻醉 应激 白细胞介素6 肾上腺素 

分 类 号：R614.2[医药卫生—麻醉学]