不同麻醉药物对鼻黏膜血流及血浆血管活性肠肽水平的影响

The effects of different anesthetic on nasal mucosal blood flow and plasma concentration of vasoactive intestinal polypeptide

目的对比丙泊酚复合瑞芬太尼静脉麻醉和异氟醚复合氧化亚氮吸入麻醉对血浆血管活性肠肽(VIP)水平及鼻黏膜血流的影响。方法将46例接受功能性鼻内镜手术(FESS)患者随机分为吸入麻醉组和静脉麻醉组,在麻醉前后分别采用放射免疫法测定血浆VIP浓度;观察麻醉前及麻醉维持20min后下鼻甲黏膜的微循环变化情况。结果吸入麻醉组血浆VIP含量较术前显著下降[(23.7±15.9)pg/mlvs(42.8±13.9)pg/ml,P﹤0.05];静脉麻醉组的血浆VIP含量较术前显著增高[(51.0±13.6)pg/mlvs(44.6±13.1)pg/ml,P﹤0.05];下鼻甲黏膜血流灌注指标显示,静脉麻醉组灌注量(PU)、血细胞平均运动速率(V)低于术前(P﹤0.05);吸入麻醉组PU值、V值较术前均无显著性差异;静脉麻醉组麻醉后PU值及V值低于吸入麻醉组(P﹤0.05)。结论丙泊酚复合瑞芬太尼全静脉麻醉可明显减少鼻黏膜血流,但不导致血浆VIP水平的降低;异氟醚复合氧化亚氮吸入麻醉使血浆VIP水平降低,但对鼻黏膜血流无明显影响。迷走神经兴奋可能是导致本研究条件下中血浆VIP升高和鼻黏膜血流减少的主要原因。

Objective To compare the effects of propofol and remifentanil with isoflurane and nitrous oxide on nasal mucosal blood flow and plasma concentration of vasoactive intestinal peptide （VIP）. Methods 46 patients undertaking functional endoscopic sinus surgery （FESS） were randomly divided into 2 groups： inhalational group and intravenous group. Nasal mucosal blood flow was measured with laser Doppler flowmetry before and after anesthesia. VIP before and after anesthesia were also determined and compared between the 2 groups. Results VIP decreases significantly in inhalational group after anesthesia [（23.7±15.9）pg/ml vs （42.8±13.9）pg/ml,P 〈 0.05] ;while in intravenous group, it increased significantly after anesthesia [（51.0±13.6）pg/ml vs （44.6±13.1）pg/ml,P 〈 0.05]. For the nasal blood flow measurement, the value of perfusion unit （PU） and blood cell moving velocity （V） in intravenous group, but not in inhalational group, decreased significantly compared with those before anesthesia （P 〈 0.05）. The value of PU and V in intravenous group were significantly lower than those in inhalational group after anesthesia （P 〈 0.05）. Conclusions Propofol and remifentanil can reduce the nasal blood flow but can not causes VIP increase; isoflurane with nitrous oxide can not reduce the nasal blood flow but can lower plasma VIP concentration. Parasympathetic never activation may be the best explanation for both increased plasma VIP concentration and decreased nasal mucosal blood flow.