不同麻醉深度对老年肠癌手术患者应激反应的影响  

Effects of different anesthesia depth on stress response in elderly patients undergoing elective laparoscopic surgery for colorectal cancer

作　　者：田可耘[1] 康茵[1] 邓龙姣[1] 刘红[1] 李海风[1] 王志鹏[1] 赵国栋[1] 

机构地区：[1]广东省人民医院//广东省医学科学院麻醉科,广东广州510080

出　　处：《南方医科大学学报》2014年第5期694-698,共5页Journal of Southern Medical University

基　　金：广东省科技计划项目(2011B061300019)

摘　　要：目的：探讨Narcotrend监测下3种不同麻醉深度对老年肠癌手术患者应激反应的影响。方法全身麻醉下行腹腔镜辅助下肠癌根治术的老年患者105例，60岁~91岁，ASAⅠ~Ⅲ级，随机均分为3组（n=35）：A组（麻醉深度维持Narcotrend指数即NI在D0水平），B组（NI在D2）和C组（NI在E1）。术中根据Narcotrend监测结果调整麻醉用药使各组麻醉深度维持在预设定目标水平。记录患者麻醉诱导前（T0）、气管插管前（T1）、气管插管后即刻（T2）、气腹前2 min（T3）、气腹后2 min（T4）、手术结束（T5）和拔管时（T6）的心率（HR）和平均动脉压（MAP）。检测患者麻醉前（Ta）、术毕（Tb）和术后第1天（Tc）的血清皮质醇（Cor）、促肾上腺皮质激素（ACTH）、血管内皮素（ET-1）、肿瘤坏死因子（TNF-a）、白介素-6（IL-6）和C反应蛋白（CRP）水平。结果与麻醉诱导前比较，A组患者心率（HR）和平均动脉压（MAP）在气管插管后即刻、气腹后2 min、拔管时明显增加（P＜0.05），且明显高于B组和C组（P＜0.05）；3组患者MAP在气管插管前、气腹前2 min均比麻醉诱导前明显降低（P＜0.05或P＜0.01），C组明显低于A组和B组（P＜0.05）；A组高血压发生率明显高于B组和C组（P＜0.05），C组低血压发生率明显高于A组和B组（P＜0.01）。3组患者的ACTH在术毕和术后第1天均明显增高（P＜0.01）；A组患者CRP、IL-6、TNF-a在术毕和术后第1天明显增高（P＜0.05或P＜0.01），且明显高于B组和C组（P＜0.05或P＜0.01）；A组和B组患者Cor在术毕和术后第1天明显升高（P＜0.05），且高于C组（P＜0.01）；C组ET-1在术毕和术后第1天明显低于A组和B组（P＜0.05或P＜0.01）。结论老年肠癌患者术中麻醉深度维持在D2和E1能较好地抑制机体的应激反应，但D2水平更有利于维持血流动力学的稳定。Objective To investigate the effects of different anesthesia depth on stress response in elderly patients undergoing elective laparoscopic surgery for colorectal cancer. Methods A total of 105 ASA I-III patients aged 60-91 years undergoing elective laparoscopic surgery for colorectal cancer with general anesthesia were randomized into 3 groups, namely group A with a target Narcotrend index （NI） maintained at D0 level, group B with a NI at D2 level, and group C with a NI at E1 level. The anesthetics （profopol and remifentanil） were adjusted according to Narcotrend monitoring results to maintain the specified anesthesia depth. The patients＆#39; heart rate （HR） and mean artery pressure （MAP） were recorded before anesthesia （T0）, before intubation （T1）, immediately after intubation （T2）, at 2 min before pneumoperitoneum （T3）, 2 min after pneumoperitoneum （T4）, at the end of the surgery （T5） and extubation （T6）. Serum levels of cortisol, adrenocorticotropic hormone （ACTH）, endothelin-1 （ET-1）, tumor necrosis factor-α（TNF-α）, interleukin-6 （IL-6） and C-reactive protein （CRP） were measured by standard ELISA and radioimmunoassay before anesthesia （Ta）, at the end of the surgery （Tb） and 1 day after the surgery （Tc）. Results HR and MAP in group A increased significantly at T2, T4, and T6 compared to those at T0 （P＆lt;0.05）, and were higher than those in group B and group C （P＆lt;0.05）. The MAP in all the 3 groups all decreased at T1 and T3 （P＆lt;0.05 or P＆lt;0.01）, and was markedly lower in group C than in groups A and B （P＆lt;0.05）. The incidence of hypertension was significantly higher in group A than in groups B and C （P＆lt;0.05）, while the incidence of hypotension was much higher in group C （P＆lt;0.01）. There were no obvious differences in serum levels of cortisol, ACTH, CRP, IL-6, TNF-a, or ET-1 among the groups at Ta （P＆gt;0.05）. The serum levels of ACTH in the 3 groups all significantly increa

关 键 词：麻醉深度 NARCOTREND 老年 应激反应 监测 

分 类 号：R614[医药卫生—麻醉学]