艾司洛尔调控腹腔镜胆囊切除术中应激反应的临床研究

Clinical study on Esmolol's effect of controlling stress reaction duing laparoscopic cholecystectomy

目的探讨艾司洛尔应用在全麻下腹腔镜胆囊切除术中调控术中应激反应,并观察其对术中异丙酚和瑞芬太尼麻醉维持用量及麻醉深度的影响。方法60例择期行全麻下腹腔镜胆囊切除术患者,随机分为三组,Ⅰ组术中麻醉维持用异丙酚、瑞芬太尼和阿曲库铵同时微泵输注,Ⅱ组和Ⅲ组在切皮前1min给予艾司洛尔0.4mg/kg,并分别在术中通过增加艾司洛尔的输注速率来降低异丙酚和瑞芬太尼的麻醉用量,术中根据血压、心率来调节泵注速度以维持其在基础值的±25%之内。采集并记录各组术前基础值、麻醉诱导气管插管、切皮、气腹1、3、5、10min、胆囊分离时共8个时间点的血压、心率及BIS值的变化;记录各组术中异丙酚、瑞芬太尼和艾司洛尔的维持用量;在术前(基础值)、气腹3min、胆囊分离时抽取外周静脉血检测血清皮质醇的浓度。结果所有患者术中麻醉均控制平稳,心率、血压均在预先设定的范围内波动。三组患者同时间点血压、心率、BIS值无显著性差异(P>0.05);Ⅱ组和Ⅲ组随着术中艾司洛尔用量的增加,异丙酚和瑞芬太尼维持用量分别明显下降,同比有显著性差异(P<0.05);三组患者气腹3min、胆囊分离时的血清皮质醇较术前基础值明显降低(P<0.05)。结论艾司洛尔在全凭静脉麻醉下腹腔镜胆囊切除术中以一定的输注速率微泵给药,能明显降低术中所需的异丙酚及瑞芬太尼的用量,明显抑制围术期的心血管反应和应激激素反应,降低手术麻醉刺激对患者的生理干扰。

Objective To explore the application of esmolol in controling stress reaction during laparoscopic cholecystectomy（LC） , and to observe its influence on the maintaing dose of propofol and reInifentanil. Methods 60 cases of selected LC under general anesthesia were ramdomly divided into 3 groups： in group Ⅰ , propofol, esmolol and atracurium were continuously infused using mini - pumps, in group Ⅱ and Ⅲ, 0.4 mg/kg of esmolol was administered before skin incision was made, dose of propofol and remifentanil was decreased by increasing the infusion speed of esmolol during operation, the change of blood pressure and heart rate were within ± 25 % of its basic value by adjusting infusion speed. The blood pressure, heart rate and BIS value at time points of basic value, of anesthetic induction on intubating, skin incision, 1 min,3 min,5 min and 10 min after pneumoperitoneum and cholecyst dissection were recorded, the maintaining dose of propefol, esmolol and remifentanil was recorded; the peripheral vascular blood were collected at the time points of basic value, 3 min after pneumoperitoneum and cholecyst dissection to test the serum cortisol level. Results The blood pressure and heart rate of all the patients were stable during the operation. There was no significant difference among the value of blood pressure,heart rate and BIS value of the three groups were at the identical time points（ P 〉 0.05） ; the maintaining dose of propofol and remifentanil decreased significantly as the dose of esmolol increased during operation in group Ⅱ and Ⅲ （ P 〈 0. 05 ） ; the serum cortisol levels at the time points of 3 rain after pneumoperitoneum and cholecyst dissection of the three groups all decreased compared with those before operation（ P 〈 0.05）. Conclusions Esmolol can significantly decrease the dose of propofol remifentanil when it was administered by mini - pump infusion in general anethesia during LC, which can reduce the press reaction perioperatively thus reducing the physical interference the operation brings to the patients.