静脉全麻或吸入全麻联合硬膜外阻滞对老年食管癌患者氧化应激反应的影响  

Observe the impact of the oxidative stress reaction in elderly post-esophagectomy patients with epidural blockade combined with intravenous general anesthesia or inhalational general anesthesia

作　　者：王海东[1] 徐维安[1] 李向前[1] 王鸿旻[1] 何平[1] 杨婉容[1] 

机构地区：[1]甘肃省肿瘤医院麻醉科,兰州市730050

出　　处：《临床麻醉学杂志》2013年第5期461-463,共3页Journal of Clinical Anesthesiology

摘　　要：目的观察丙泊酚或异氟醚联合胸段硬膜外阻滞对老年食管癌患者手术氧化应激反应的影响。方法随机选择行食管癌根治术的老年患者60例,男52例,女8例,ASAⅠ或Ⅱ级,随机均分为丙泊酚全麻联合胸段硬膜外阻滞组(P组),异氟醚吸入麻醉联合胸段硬膜外阻滞组(I组)。P组采用血浆靶控输注丙泊酚4～6mg·kg-1·h-1,I组采用1%～2%的异氟醚持续吸入。两组术中均按需静脉持续泵注芬太尼和维库溴铵,并于手术结束前5min分别停止丙泊酚输注和异氟醚吸入。两组均于入室后(T0)、单肺通气时(T1)、手术2h时(T2)、手术结束时(T3)、术后2h(T4)、术后24h(T5)抽取静脉血,测定血浆丙二醛(MDA)、一氧化氮(NO)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)含量。结果各时点两组患者SBP、DBP、HR差异均无统计学意义。与T0时比较,T1、T2时P组和T1～T5时I组血浆NO、MDA含量明显升高(P<0.05);T1～T5时I组血浆SOD和GSH-Px含量明显降低(P<0.05)。与I组比较,T3～T5时P组血浆NO和MDA含量明显降低、而血浆SOD和GSH-Px含量明显升高(P<0.05)。两组患者术中麻醉诱导时间、维持时间、输液量、出血量、尿量、芬太尼和维库溴铵用量差异均无统计学意义。结论丙泊酚能更好地降低老年食管癌患者手术的氧化应激水平,对老年食管癌患者的预后有一定的帮助。Objective To observe the influence of the oxidative stress reaction in elderly post- esophagectomy patients with epidural blockade combined with either propofol or isoflurane. Methods Choose sixty elderly post-esophagectomy patients, 52 female, 8 male, the age between 68- 78, the weight between 45-83 kg, ASA I or Ⅱ. The patients were randomly divided into two groups （n=30）： Propofol combined with epidural blockade （group P）, Isoflurane combined with epidural blockade（group I）. Group P with plasma target control infusion with 4-6 mg. kg-1 · h-1 of propofol, group I with 1%-2%isoflurane continuous inhalation. Both groups pump into fentanyl and inject vecuronium during the surgery. Pump stop 5 minutes before the surgery. We sample the plasma for malondialdehyde （ME）A）, nitric oxide （NO）, superoxide dismutase （SOD）, valley oboro kennedy skin peroxidase （GSH-Px） in both groups before surgery （To）,one lung ventilation （T1）, 2 h during surgery （T2）, surgery end （T3） and 2 h postoperatively （T4） and 24 h postoperatively （T5） in venous blood. Results NO and MDA level in plasma rises at T0-T2 and decreases at T3-T5 in group P, the level at T1 and T2 higher than To （P〈0.05）. The vitality of SOD and GSH-Px in plasma do not change significantly. The NO and MDA level in plasma rises at T0-T4 and decline at T~ in group, the level at T1-T5 is higher than To （ P 〈 0. 05 ）. The vitality of SOD and GSH-Px in plasma continuous decrease significantly and especially before the surgery （ P〈 0. 05 ）. The level of NO, MDA, SOD and GSH-Px in plasma have statistical difference at T0 in group P, but lower at T3-T5 compared with group I. Conclusion Propofol can reduce the oxidative stress reaction effectively comparing to isoflurane, and have some help on the prognosis of elderly post-esophagectomy patients.

关 键 词：丙泊酚 异氟醚 老年食管癌 氧化应激 

分 类 号：R614[医药卫生—麻醉学]