两种麻醉方案用于心脏瓣膜置换术患者的临床效果对比研究  

Comparative Study of Two Different Anesthetic Plans for Patients Undergoing Heart Valve Replacement

作　　者：李祥奎[1] 黄建新[1] 万永灵[1] 王瑜[1] 周木香[1] 兰志勋[1] 

机构地区：[1]四川省医学科学院.四川省人民医院麻醉科,四川成都610072

出　　处：《昆明医学院学报》2010年第2期67-72,共6页Journal of Kunming Medical College

摘　　要：目的比较小剂量芬太尼复合丙泊酚靶控输注静脉麻醉与传统异氟醚静吸复合麻醉应用于心脏瓣膜置换术的临床效果及对炎性因子和血浆皮质醇的影响.方法60名接受心脏瓣膜置换术患者被随机分为小剂量芬太尼复合丙泊酚靶控输注静脉麻醉组(试验组)30例与传统异氟醚静吸复合麻醉组(对照组)30例.两组分别于麻醉诱导前(T)1、插管前(T)2、插管(T)3、插管后5分(T)4、切皮前(T)5、切皮(T)6、切皮后5min(T)7、升主动脉插管(T)8、术毕(T)9记录收缩压(SBP)、心率(HR)及切皮前至术毕中心静脉压(CVP)指标,采取外周静脉血以酶联免疫吸附法检测麻醉诱导前(T▲)1、切皮后10min(T▲)2、CBP后10min(T▲)3、停心肺转流术(cardopu lmonary bypass,CPB)后10min(T▲)4及停CBP后4h(T▲)5血浆IL-6、IL-8水平,并检测T▲1-5各时点血清皮质醇水平.结果(1)试验组各时间点芬太尼用量及总量较对照组少,组间比较差异有统计学意义(P<0.05);(2)试验组患者血浆IL-6、IL-8T▲3、T▲4水平较对照组低(P<0.05);(3)试验组患者T▲2、T▲3时间点血清皮质醇水平较对照组高(P≤0.05);(4)试验组患者术后清醒时间短、气管导管拔除早(P<0.01).结论小剂量芬太尼复合丙泊酚靶控输注静脉麻醉能维持患者的心脏瓣膜置换术适度应激状态,降低炎性反应,术后早期恢复并拔管,该麻醉方案安全可靠,值得临床推广应用.Objective To compare the effects of intravenous anesthesia using propofol target-controlled infusion（TC）I combined with low dose fentanyl and traditional intravenous and inhalational isoflurane on the levels of perioperative plasma inflammatory cytokines and plasma hydrocortisone in patients undergoing heart valve replacement.Methods Sixty patients undergoing heart valve replacement were randomly divided into two groups.The experimental group（n =30） ：patients received intravenous anesthesia using propofol target-controlled infusion combined with lowdose of fentanyl through the internal carotid vein after intubation.The control group（n =30）：patients received intravenous and inhalational isoflurane.SBP、 HR、 CVP were monitored before anesthesia induction（T）1,before tracheal intubation（T）2,tracheal intubation（T）3,5 minutes after tracheal intubation（T）4,before incision（T）5,incision（T）6,5 minutes after incision（T）7,ascending aortic intubation（T）8,the end of operation（T）9 and the post-operative recovery between the two groups was compared.Venous blood samples were taken for measurements of perioperative plasma inflammatory cytokines of IL6,IL8 concentrations and the levels of plasma hydrocortisone with ELISA before anesthesia induction（T▲）1,10 minutes post-incision（T▲）2,10 minutes after CBP（T▲）3,10 minutes after stopping CBP（T▲）4 and 4 hours after stopping CBP（T▲5）.In addition,the levels of blood serum corticosteroid between the two groups were measured at T▲1-5.Results The drug consumption of fentanyl in experimental group was less than the control group（P0.05）.（2） Levels of perioperative plasma inflammatory cytokines IL-6,IL-8 at T▲ 3、T▲4 in experimental group were lower than the control group（P0.05）.（3） Levels of plasma hydrocortisone at T▲2,T▲3 in experimental group were higher than the control group（P0.05）.（4） The recovery time and endotracheal catheter removal in experimental group were shorter

关 键 词：心脏瓣膜置换术 丙泊酚 硫酸镁 白细胞间介素-6 白细胞间介素-8 皮质醇 麻醉 

分 类 号：R614[医药卫生—麻醉学]