不同剂型丙泊酚对直肠癌腹腔镜手术病人内皮系统和生化功能的影响  

Effects of different dosage forms of propofol on endothelial system and biochemical function in patients undergoing laparoscopic surgery of rectal cancer

作　　者：熊添[1] 樊宏[1] 赵基鹏 李昊[1] XIONG Tian;FAN Hong;ZHAO Jipeng(Department of Anesthesiology,Beijing Aerospace General Hospital,Beijing 10076,China)

机构地区：[1]北京航天总医院麻醉科,100076

出　　处：《临床外科杂志》2021年第7期669-672,共4页Journal of Clinical Surgery

摘　　要：目的探讨中长链脂肪乳剂和长链脂肪乳剂丙泊酚对直肠癌腹腔镜手术病人内皮系统和生化功能的影响.方法2017年5月~2019年5月我院行直肠癌腹腔镜手术的病人126例,随机分为长链脂肪乳剂丙泊酚组(L组)和中长链脂肪乳剂丙泊酚组(M组).比较两组病人麻醉效果、不良反应发生率、内皮素(ET)和降钙素基因相关肽(CGRP)和生化指标的差异.结果L组和M组的麻醉起效时间分别为(2.5±1.1)分钟和(2.1±0.6)分钟、完全阻滞时间分别为(1.7±0.7)分钟和(1.5±0.4)分钟、恢复自主呼吸时间分别为(6.5±1.9)分钟和(5.2±1.3)分钟、手术时间分别为(275.1±33.8)分钟和(279.6±41.2)分钟、意识消失浓度分别为(1.9±1.0)μg/ml和(2.1±0.6)μg/ml,术中丙泊酚用量分别为(1523.4±128.7)mg和(1567.9±141.2)mg,两组比较差异无统计学意义(P>0.05).两组不良反应发生率比较差异无统计学意义(P>0.05).T2、T3时L组和M组ET均值分别为(133.5±19.6)pg/ml和(130.4±22.0)pg/ml、(131.2±18.7)pg/ml和(122.7±17.9)pg/ml,差异有统计学意义(P<0.05),CGRP均值分别为(60.4±7.8)pg/ml和(63.1±8.1)pg/ml、(61.3±8.1)pg/ml和(63.6±10.2)pg/ml,差异有统计学意义(P<0.05).手术后L组和M组丙氨酸氨基转移酶(ALT)和门冬氨酸氨基转移酶(AST)均值分别为(32.5±5.1)U/L和(29.0±5.3)U/L、(35.9±6.8)U/L和(32.7±6.5)U/L,均明显升高(P<0.05),两组间比较差异无统计学意义(P>0.05).L组甘油三酯(TG)为(1.8±0.3)mmol/L、低密度脂蛋白(LDL)为(2.8±0.8)mmol/L,手术后水平升高,差异有统计学意义(P<0.05),M组分别为(1.4±0.7)mmol/L和(2.6±0.8)mmol/L,两组比较差异有统计学意义(P<0.05).结论不同剂型的丙泊酚对直肠癌腹腔镜手术病人麻醉作用相当,均能通过降低ET水平和升高CGRP水平发挥内皮功能保护作用,M组效果更佳.L组有高TG、LDL血症.Objective To investigate the effects of medium-long and long chain fat emulsion propofol on endothelial system and biochemical function in patients with rectal cancer undergoing laparoscopic surgery.Methods From May 2017 to May 2019,126 patients with rectal cancer undergoing laparoscopic surgery in our hospital were randomly divided into a long-chain fat emulsion propofol group(Lgroup)and a medium-long chain fat emulsion propofol group(M group).Anesthesia effect,incidence of adverse reactions,endothelin(ET),Calcitonin gene-related peptide(CGRP)and biochemical function of the two groups were compared.Results After laparoscopic surgery with different dosage forms of propofol,there was no difference between the two groups in the onset time of anesthesia[(2.5±1.1)minand(2.1±0.6)min,respectly],time of complete block[(1.7±0.7)min and(1.5±0.4)min],time of recovery of spontaneous breathing[(6.5±1.9)min and(5.2±1.3)min],operation time[(275.1±33.8)minand(279.6±41.2)min)],concentration of unconsciousness[(1.9±1.0)μg/mland(2.1±0.6)μg/ml],amount of propofol consumption[(1523.4±128.7)mgand(1567.9±141.2)mg](P>0.05).The anesthesia indexes and the incidence of adverse reactions of the two groups were similar(P>0.05).During the operation(T2、T3),the ET level[(133.5±19.6)pg/mland(130.4±22.0)pg/ml、(131.2±18.7)pg/mland(122.7±17.9)pg/ml,respectly]of both groups decreased,and the CGRP level[(60.4±7.8)pg/mland(63.1±8.1)pg/ml、(61.3±8.1)pg/mland(63.6±10.2)pg/ml,respectly]increased(P<0.05);compared to that of group L,the ET level of group M was significantly lower and CGRP level was higher(P<0.05).alanine aminotransferase(ALT)and Aspartate aminotransferase(AST)levels of two group were significantly increased after operation[(32.5±5.1)U/Land(29.0±5.3)U/L、(35.9±6.8)U/Land(32.7±6.5)U/L,respectly]compared to that of pre-operation(P<0.05),there was no difference in two group(P>0.05).Triglyceride[TG,(1.8±0.3)mmol/L]and low-density lipoprotein[(LDL,(2.8±0.8)mmol/L]levels of group L were significantly increased(P

关 键 词：丙泊酚 直肠癌 腹腔镜手术 内皮系统损伤 肝损伤 

分 类 号：R614[医药卫生—麻醉学] R735.37[医药卫生—外科学]