异丙酚和哌氟合剂辅助连硬外阻滞下行胆囊切除术血浆内皮素和一氧化氮浓度变化  

Effects of Propofol and Pethidine-droperidol on the Concentration of Endothlium and Nitric Oxide during Cholecystectomy under Epidural Blockade

作　　者：李娟[1] 殷惠新[1] 陈昆洲[1] 

机构地区：[1]安徽省立医院麻醉科,合肥市230001

出　　处：《临床麻醉学杂志》2000年第10期495-496,共2页Journal of Clinical Anesthesiology

摘　　要：目的 :观察异丙酚和哌氟合剂作为硬膜外辅助用药的临床效果及其对术中血浆内皮素 (ET)和一氧化氮(NO)水平的影响。方法 :2 1例择期胆囊切除病人随机分为两组。麻醉完善后 ,Ⅰ组用微泵输注异丙酚 2mg·kg-1·h-1;Ⅱ组给于哌替啶 5 0mg ,氟哌啶 2 5mg静注。于麻醉前、麻醉后、牵拉胆囊及术终抽静脉血测定NO和ET的含量。结果 :麻醉后两组病人BP、ET值均明显下降 ,NO值升高 ;牵拉胆囊时HR、BP、NO和ET均下降 ;Ⅰ组“胆 心反射”发生率低于Ⅱ组。结论 :麻醉后BP下降有神经及体液因素参与。牵拉胆囊时的BP下降可能系以神经调节因素占主导。小剂量异丙酚仍不能完全消除内脏牵拉反应 ,但可提供一定的心肌保护作用。Objective:To evaluate the effect of propofol or pethidine droperidol as an adjuvant for episural blockade on the change of ET and NO in patients undergoing cholecystedmy.Methods:21 patients undergoing cholecystectomy were allocated randomly into two groups.After epidural blockade,propofol was infused at a rate of 2mg·kg -1 ·h -1 in group Ⅰ( n= 10).In group Ⅱ( n= 11),pethidine 50mg and droperidol 2 5mg were injected.Venous blood samples were taken before and after epidural block,during gallbladder traction and after surgery separately to measure the concen tration of NO and ET.Results:After epidural block,there were significant decreases in BP and ET with a markedly increase in concentration of NO in both groups.During gallbladder traction,evident decreases were found in BP,NO and ET in both groups.The incidences of chole cardi ac reflex in group Ⅰ was lower than that in group Ⅱ.Conclusion:Neuroregulation and humoral regulation are involved in the decrease of BP after epidural block.The reduction of BP during pulling cholecyst may be mostly caused by the element of neuroregulation.Low dose propofol is not effective enough to eliminate visceral traction reaction completely,but can provide a suitable myocardial protection.

关 键 词：异丙酚 硬膜外阻滞 -氧化氮 内皮素 胆囊切除术 

分 类 号：R614[医药卫生—麻醉学]