雷米芬太尼全凭静脉复合麻醉与异氟醚吸入麻醉对机体应激反应的影响

Effects of anesthesia of propofol with remifentanil or isoflurane inhalation on perioperative stress responses

目的比较雷米芬太尼丙泊酚全凭静脉麻醉(TIVA)与异氟醚丙泊酚静吸复合麻醉对机体应激反应的影响。方法ASAⅠⅡ级普外科手术患者40例,随机分为雷米芬太尼复合丙泊酚组(Remi组)和异氟醚复合丙泊酚组(Iso组),每组20例。在相同诱导方案完成插管后,TIVA组以雷米芬太尼0.1～0.2μg·kg-1·min-1复合丙泊酚3～5mg·kg-1·h-1维持麻醉;Iso组以1%～2.0%异氟醚复合丙泊酚3～5mg·kg-1·h-1维持麻醉。测定麻醉前、手术开始后15、60min的血糖(Glu)、血浆去甲肾上腺素(NE)、皮质醇(Cort)的浓度,以及术后24、72h的血浆Cort浓度。结果手术开始后15和60min,Remi组的Glu为(5.0±0.6)mmol/L和(5.2±0.4)mmol/L,NE为(188.7±134.7)ng/ml和(151.6±95.1)ng/ml,Cort为(10.6±3.8)μg/ml和(18.2±5.3)μg/ml,均明显低于同一时点Iso组所测值:Glu为(7.1±1.0)mmol/L和(8.7±0.5)mmol/L;NE为(295.3±176.7)ng/ml和(434.7±224.7)ng/ml;Cort为(15.6±8.9)μg/ml和(26.0±5.5)μg/ml(P<0.05)。Remi组术后24h血浆皮质醇浓度为(22.8±5.7)μg/ml也明显低于Iso组的(28.2±6.3)μg/ml(P<0.05)。结论与异氟醚复合丙泊酚麻醉比较,雷米芬太尼复合丙泊酚能明显降低术中、术后机体的应激反应。

Objective To compare the stress response during anesthesia with intravenous remifentanil(Remi)or inhaled isoflurane(Iso).Methods Forty ASA Ⅰ-Ⅱ patients undergoing selective abdominal surgery were randomly divided into Remi group(n=20)and Iso group(n=20).Anesthesia was induced with same method in both groups.Anesthesia was maintatined with remifantanil(0.1～0.2 μg·kg -1 ·min -1 )and propofol (3～5 mg·kg -1 ·h -1 )in group Remi and with isoflurane(1%～2%)and propofol(3～5 mg·kg -1 ·h -1 )in group Iso.The plasma levels of cortisol,norepinephrine and glucose were determined before anesthesia,at 15,60 min after beginning of surgery.The plasma level of cortisol was determined at 24,72 h after operation additionally.Results At 15,60 min after beginning of surgery,the plasma levels of cortisol (10.6±3.8 vs 15.6±8.9 μg·ml -1 ,18.2±5.3 vs 26.0±5.5 μg·ml -1 ,P<0.05)and norepinephrine(188.7±134.7 vs 295.3±176.7 ng/ml,151.6±95.1 ng/ml vs 434.7±224.7 ng/ml,P<0.05)were significantly lower in group Remi than those in group Iso,and the level of glucose was significantly lower in group Remi (5.0±0.6 mmol/L,5.2±0.4 mmol/L ) than that in group Iso (7.1±1.0 mmol/L,8.7±0.5 mmol/L,P<0.05).The plasma level of cortisol was significantly lower in group Remi(22.8±5.7 μg/ml) than that in group Iso(28.2±6.3 μg/ml P<0.05)at 24 h after operation.Conclusion Anesthesia with intravenous remifentanil can reduce perioperative stress response more than that with inhaled isoflurane.