不同全麻诱导药对循环及内分泌功能的影响  

Effects of three intravenous anesthetics on circulatory and pituitary-adrenal functions during induction

作　　者：冯荣芳[1] 孟庆云[1] 柳顺锁[1] 刘志双[1] 兰长生[2] 杨敬霞 张亚超[4] 

机构地区：[1]河北医科大学第三附属医院麻醉科,石家庄市050051 [2]河北医科大学第三附属医院同位素室,石家庄市050051 [3]河北医科大学第三附属医院骨科研究所,石家庄市050051 [4]白求恩军医学院中心实验室

出　　处：《中华麻醉学杂志》2001年第1期14-17,共4页Chinese Journal of Anesthesiology

摘　　要：目的　评价三种静脉药在全麻诱导时对循环、垂体 肾上腺皮、髓质内分泌功能的影响。方法　将择期全麻手术病人 43例 ,随机分为三组 :Ⅰ组 (异丙酚 2 5mg/kg) 15例 ;Ⅱ组 (硫喷妥钠 5mg/kg)和Ⅲ组 (依托咪酯 0 3mg/kg)各 14例。行桡动脉直接测压 ,同时连续监测ECG、SpO2 。快速静注琥珀胆碱 1 5～ 2 0mg/kg行气管插管。插管 2min后静注维库溴铵 4mg ,5min后各组吸入安氟醚维持 1 3MAC ,15min后复合吸入N2 O。在诱导前 (T0 ) ,窥喉插管即刻 (T1) ,插管后 2min(T2 ) ,5min(T3 ) ,15min(T4 )取外周静脉血测定血浆去甲肾上腺素 (NE)、肾上腺素 (E)、皮质醇 (cort)、泌乳素 (PRL)、生长素 (GH)、β 内啡肽 (β EP)、胰岛素和血糖的水平。 结果　异丙酚诱导气管插管能抑制高血压反应 ,不增加心肌耗氧量 ,明显优于硫喷妥钠和依托咪酯 ;三药诱导气管插管均不能抑制E和NE升高 ;均使腺垂体分泌PRL增加 ,而GH、β EP无变化 ;插管后 15min依托咪酯使肾上腺皮质分泌cort减少 ;使血糖升高 ,胰岛素降低 ;说明对糖耐量呈现抑制作用。结论　异丙酚对循环和内分泌影响较小 。Objective Induction of general anesthesia and endotracheal intubation may have profound effects on hemodynamic and endocrine functions and result in serious complications and even death.We compared the effects of propofol, thiopental and etomidate on the circulatory and pituitary-adrenal functions in order to evaluate the efficacy and safety of the agents.The study may provide useful information for clinical selection of induction agents.Methods Forty-three patients undergoing elective surgery were randomly divided into three groups.Before induction radial artery was cannulated for continuous monitoring of blood pressure and heart rate, ECG and SpO 2 were also monitored continuously.Anesthesia was induced with intravenous propofol 2.5mg/kg (groupⅠ), thiopental 5mg/kg (groupⅡ),or etomidate 0.3mg/kg(group Ⅲ).Succinylcholine was then administered intravenously to facilitate intubations.2 min after intubation vecuronium 4mg/kg was given IV; 5 min after intubation enflurane inhalation was started and maintained at 1.3MAC, at 15th min nitrous oxide was given.All patients were mechanically ventilated.End-tidal enflurane was monitored by Datex gas detector.Blood samples were taken from peripheral vein for the measurement of NE,E,PRL, GH,β-EP,insulin and blood glucose before induction (T 0), during intubation (T 1) and 2,5,15 min after intubation.Results The study showed that propofol attenuated the increase in BP and the oxygen consumption of myocardium during induction and intubation. None of the three drugs inhibited increase in E and NE during induction and intubation.They all increased PRL secretion from pituitary gland but produced no effects on blood on GH and β-EP.Etomidate inhibited the cortisol secretion and increased plasma glucose level and decreased insulin secreation at 15th min after intubation.Conclusions Propofol has less effects on circulatory and pituitary-adrenal functions , and is an intravenous anesthetic of choice for induction.

关 键 词：全麻醉导药 异丙酚 硫喷妥钠 依托咪酯 循环功能 内分泌功能 

分 类 号：R614.1[医药卫生—麻醉学]