不同麻醉方式对不停跳冠状动脉旁路移植术患者应激反应的影响

Effects of different anesthetic techniques on perioperative stress response in patients undergoing off-pump coronary artery bypass grafting

目的 比较三种不同麻醉方式对不停跳冠状动脉旁路移植术（OPCABG）患者应激反应的影响。方法AsAⅡ～Ⅲ级行OPCABG患者54例，随机分三组：丙泊酚靶控输注（TCI）组（Ⅰ组）、异氟醚组（Ⅱ组）、丙泊酚TCI复合异氟醚吸入组（Ⅲ组），每组18例。在麻醉诱导前（T0）、切皮后（T1）、劈胸骨后（T2）、手术结束时（T3）观察HR、MAP，在T0、T2、T3及术后18h（T4）测定血糖（Glu）、血浆肾上腺素（E）、血清促肾上腺皮质激素（ACTH）、皮质醇（Cor）及白细胞介素-6（IL-6）浓度。结果Ⅱ组在T0、T2及T3时的HR均明显高于Ⅰ组和Ⅲ组（P〈0．05）。三组患者T3时Glu、血清ACTH、Cor及IL-6均明显高于T0时（P〈0．05）；而Ⅲ组患者Glu、血浆E、血清ACTH、Cor及IL-6都明显低于Ⅰ组和Ⅱ组（P〈0．05）。结论丙泊酚TCI复合异氟醚吸入维持OPCABG麻醉能明显地抑制手术引起机体的应激反应。

Objective To compare the effect of different anesthetic techniques on the stress response in patients undergoing off-pump coronary artery bypass grafting （OPCABG）. Methods Fifty-four ASA Ⅱ-Ⅲ patients undergoing OPCABG were randomly divided into three roups：propofol TCI（group Ⅰ ）, isoflurane group （group Ⅱ ） and TCI propofol plus isoflurane inhalation （group Ⅲ）. Anesthesia was induced with same method in three groups and maintained with different anesthetic techniques. MAP and HR were recorded before operation （T0）, after the incision （T1）, after thoracotomy （T2） ,at the end of operation （T3）. Serial blood samples were taken T0, T2 ,T3 ,and at 18 h after operation （T4） for the measurements of concentrations of blood glucose, plasma epinephine, serum cortisol, ACTH and IL-6. Results The HR in group Ⅱ was significantly higher than that in group Ⅰ and Ⅲ at T1 ,T2, T3（P〈0. 05）. The concentrations of glucose, epinephrine, ACTH, cor tisol and IL-6 in group Ⅲ were significantly lower than those in group Ⅰ and Ⅱ at T3 （P〈0.05）. Conclusion Anesthetic maintenance with propofol TCI combined with isoflurane inhalation can reduce perioperative stress response better than that with TCI propofol or inhaled isoflurane alone.