腹腔镜胆囊切除术两种麻醉方法对老年人应激反应的影响

Effects of Two Anaesthesia Methods on Stress Reaction in Old Patients Undergoing Laparoscopic Cholecystectomy

[目的]探讨丙泊酚靶控输注全凭静脉麻醉与七氟醚静吸复合麻醉对腹腔镜胆囊切除术中老年人应激反应的影响。[方法]50例全麻下行择期腹腔镜胆囊切除术的老年病人，随机分为丙泊酚组（P组）和七氟醚组（S组），每组25例。于麻醉诱导前10min（T0），麻醉诱导后10min（T1）、气腹后30min（T2）、气腹后60min（T3）及术毕30min（T4）五个时点采集患者的静脉血，测定血浆去甲肾上腺素（NE），肾上腺素（E），皮质醇（Cor），白细胞介素-6（IL-6）浓度。并于各时点记录血流动力学指标：心率（HR）、无创动脉血压（NIBP）。[结果]①各时点两组间血流动力学变化比较无统计学差异（P〉0．05）；②在T1～4时，S组去甲肾上腺素，肾上腺素，皮质醇水平较P组明显降低（P〈0．01）；T4时S组血浆白细胞介素-6水平较P组低（P〈0．01）。[结论]七氟醚较丙泊酚能更有效的抑制老年病人的交感神经兴奋，减轻机体的应激反应，并能更有效的抑制机体由于过度刺激所造成的炎性反应。

[Objective]To explore the effects of Propofol TCI（target-controlled infusion） TIVA （total intravenous anesthesia） and sevoflurane combined with venous-inspiratory anesthesia on stress reaction in old patients undergoing laparoscopic cholecystectomy. [Methods] Fifty old patients with intubation general anesthesia undergoing laparoscope cholecystectomy were randomly divided into propofol group （group P, n = 25） and sevoflurane group （group S, n =25）. Patients vein blood was collected in five time points： 10min before anesthesia（T0）, 10min after anesthesia （T1）, 30min after pneumoperitoneum （T2）, 60min after pneumoperitoneum （T3） and 30min after operation （T4） to measure the level of norepinephrine （NE）, epinephrine（E） ,cortex （Cor） and interleukin-6 （IL-6）. Meanwhile, hemodynamic index, heart rate （HR）and non-invasive arterial blood pressure（NIBP） were recorded in each time point. [Results]（i）In T0-4, HR, SBP, DBP and MAP in two groups had no obvious difference（ P 〉0. 05）. （1）Compared with group P, the levels of plasma norepinephrine, epinephrine and cortex in group S were decreased during T1-4 （ P〉0.01）, and interleukin-6 was de- creased on T4 （ P〈0.01） [Conclusion] Compared with propofol, sevoflurane can more effectively restrain the excitement of old patients＂ sympathetic nerve so as to lighten body stress reaction. Sevoflurane can more effectively restrain body inflammation reaction due to excessive stimulation than that of propofol.