丙泊酚靶控输注辅助硬膜外麻醉对手术应激反应的影响

The effect of propofol target controlled infusion on stress response during epidural blockale

目的观察丙泊酚靶控输注(TCI)用于辅助硬膜外麻醉对围术期促肾上腺皮质激素(ACTH)、皮质醇、血糖及心率(HR)、平均动脉压(MAP)的影响.方法选择30例ASA Ⅰ～Ⅱ级,择期行子宫切除术的病人随机分为两组.Ⅰ组在硬膜外麻醉平面确定时丙泊酚TCI目标血药浓度1.5 μg/ml;Ⅱ组作为对照组,单纯硬膜外麻醉,不使用TCI.于术前(T1)、术中(T2)、术毕(T3)抽取静脉血检测血糖、皮质醇、ACTH,同时记录各时点HR、MAP.结果Ⅰ组皮质醇随手术进程逐渐升高,但与基础值比无显著性差异,且在术中及术毕显著低于Ⅱ组;Ⅱ组皮质醇在术中及术毕显著高于基础值;Ⅰ、Ⅱ组ACTH在术中及术毕均显著升高,且Ⅱ组ACTH在术中及术毕均显著高于Ⅰ组.Ⅰ组血糖无显著变化,Ⅱ组血糖在术中术毕显著升高.结论丙泊酚可能通过抑制垂体ACTH释放的增加抑制皮质醇的分泌,从而避免了围术期过度的应激反应.

Objective To evaluate the effect stress response during epidural anesthesia. Methods of propofol target controlled infusion（TCI） on Thirty ASA Ⅰ-Ⅱ patients undergoing hysterectomy were randomly allocated into group Ⅰ （propofol TCI of 1.5μg/ml during operation） and group Ⅱ （without propofol） . HR and MAP were recorded, and the concentration of blood glucose, serum cortisol, ACTH were determined before operation（T1 ）, uterus removal（T2） and at end of the surgery （T3）. Results In group Ⅰ , serum ACTH slightly rised during operation, which was significantly lower than that In group Ⅱ. In group Ⅱ , serum cortisol at T2 and T3 was significantly higher than that at T1. In both groups, ACTH was significantly rised at T2 and T3, which in group Ⅰ was significantly lower than that in group Ⅱ. Blood glucose at T2 and T3 was significantly higher than that at T1 in group Ⅱ. Conclusion Propofol restrained the secretion of cortisol by inhibition of ACTH, which is beneficial to reducing excessive surgical stress response.