不同ABO血型病人应激反应的比较

Comparison of stress response in patients of different ABO blood group

目的比较不同ABO血型病人的应激反应。方法择期全麻病人A、B、AB、O血型各15例，年龄30～50岁，体重50～70虹，根据血型分为A组、B组、AB组和O组。在气管插管诱发应激状态下观察应激反应水平，于麻醉诱导前即刻（基础状态）、气管插管即刻、气管插管后1、5、10min时记录平均动脉压（MAP）和心率（HR），同时采集中心静脉血样5ml，应用酶联免疫法测定血浆肾上腺素、去甲肾上腺素和多巴胺浓度，计算各时点测定值与基础值的差值以反映各指标变化幅度。结果与A组比较，B组、AB组和O组MAP、HR、血浆肾上腺素、去甲肾上腺素、多巴胺浓度的升高幅度降低（P〈0．01）；与AB组比较，B组和O组MAP、HR、血浆肾上腺素、去甲肾上腺素、多巴胺浓度的升高幅度降低（P〈0．01）；B组和O组各指标比较差异无统计学意义（P〉0．05）。结论A型血病人应激反应明显强于其他血型病人，其次是AB型血病人，B型和O型血病人应激反应较弱。

Objective To compare the stress response in patients of different ABO blood group. Methods Sixty patients of blood group A, B, AB and O （15 in each blood group）, aged 30-50 yr, weighing 50-70 kg, scheduled for surgeries under general anesthesia were divided into 4 groups according to the blood group ： group A, group B, group AB and group O. The patients were premedieated with intramuscular scopolamine 0.3 mg. Anesthesia was induced with iv infusion of midazolam 0.05 mg/kg, propofol 1 mg/kg, fentanyl 4 ug/kg and sueeinylcholine 1.5 mg/kg. The patients were mechanically ventilated after tracheal intubation. BIS was maintained at 40-50. Anesthesia was maintained with iv infusion of propofol at 100 ug· kg^-1·min^-1 and remifentanil at 0.2ug· kg^-1·min^-1 and intermittent iv boluses of vecuronimn 0.08 mg/kg. MAP and HR were monitored and recorded before induction of anesthesia （baseline, To ） and at 0, 1, 5 and 10 rain after tracheal intubation （T1-4）. Central venous blood samples were taken simultaneously to determine the plasma concentrations of epinephrine, norepinephrine and dopamine. Results The increasing amplitude in MAP, HR and plasma concentrations of epinephrine, norepinephrine and dopamine was significantly decreased in group B, AB and O compared with group A, and in group 13 and O compared with group AB （P 〈 0.01） . However, there were no significant difference in the each index between group B and group O （ P 〉 0.05 ）. Conclusion The stress response is the strongest in the patients of blood group A, followed by blood group AB and then blood group B and O.