异丙酚和七氟烷对全麻病人短时间吸入纯氧诱发氧化应激反应的影响

Effects of propofol and sevoflurane on oxidative stress response induced by short period pure oxygen inhalation during general anesthesia

目的 评价异丙酚和七氟烷对全麻病人短时间吸入纯氧诱发氧化应激反应的影响.方法 择期拟行开腹手术全麻病人60例,年龄20～60岁,体重50～85kg,ASAⅠ或Ⅱ级,随机分为4组（n=15）,各组均依次静脉注射舒芬太尼0.1～0.2 mg/kg、咪达唑仑0.02 mg/kg、异丙酚1～2 mg/kg和罗库溴铵0.6～0.8 mg/kg麻醉诱导,气管插管后行机械通气.麻醉维持：Ⅰ组和Ⅱ组静脉输注异丙酚100～150μg·kg^-1·min-^1,FiO2分别为40%和100%,Ⅲ组和Ⅳ组吸入1.5%～3.0%七氟烷,FiO2分别为40%和100%,各组均静脉输注瑞芬太尼0.5～1.0μg·kg^-1·min^-1,间断静脉注射罗库溴铵0.15 mg/kg,维持BIS 40～60.于麻醉诱导前（基础状态）、气管插管后2、4、6h、术后24h时（T1-4）采集动脉血样,测定PaO2、血清8-异前列腺素F2α（8-iso-PGF2α）、MDA浓度和SOD活性,并计算PaO2/FiO2.结果 与基础值比较,T1-3时Ⅰ组、Ⅱ组和Ⅲ组PaO2/FiO2升高,Ⅳ组血清8-iso-PGF2α和MDA浓度升高,SOD活性降低（P〈0.05或0.01）.与Ⅱ组和Ⅲ组比较,Ⅳ组T1～3时PaO2/FiO2降低,血清8-iso-PGF2α和MDA浓度升高,SOD活性降低（P〈0.05）.Ⅰ组与Ⅱ组间上述指标比较差异无统计学意义（P〉0.05）.结论 静脉输注异丙酚100～150μg·kg^-1·min^-1维持麻醉可抑制全麻病人短时间（≤6 h）吸入纯氧诱发氧化应激反应,而吸入1.5%～3.0%七氟烷维持麻醉则不能.

Objective To investigate the effects of propofol and sevoflurane on oxidative stess response induced by short period pure oxygen inhalation during general anesthesia.Methods Sixty ASA Ⅰ or Ⅱ patients aged 20-60 yr weighing 50-85 kg undergoing elective abdominal surgery under general anesthesia were randomly divided into 2 groups （n=30 each）：group propofol （group P） and group sevoflurane （group S）.Each group was further divided into 2 subgroups inhaling 40% O2 （P0.4,S0.4） and 100%O2（P1.0,S1.0） respectively during operation.Anesthesia was induced with propofol 1-2 mg/kg,midazolan 0.02 mg/kg and sufentanil 0.1-0.2 mg/kg.Tracheal intobation was facilitated with rocuronium 0.6-0.8 mg/kg.The patients were mechanically ventilated（VT 8 ml/kg,RR 12 bpm）.PET CO2 was maintained at 35-40 mmHg.Anesthesia was maintained with in both groups.BIS was maintained at 40-60.Arterial blood samples were collected immediately before induction of anesthesia （baseline）,at 2,4,6h after tracheal intubation（T1-3） and 24h after operation（T4） for determination of PaO2,serum 8-iso-PGF2α and MDA concentrations and SOD activity.PaO2/FiO2 was calculated.Results In subgroup S1.0 the serum 8-iso-PGF2α and MDA concentrations were significantly increased while serum SOD activity was significanfly decreased at T1-3 as compared with the baseline.Serum 8-iso-PGF2α and MDA concentrations were significantly higher while serum SOD activity and PaO2/FiO2 were significantly lower at T1-3 in subgroup S1.0 than in stress response induced by≤6h pure O2 inhalation but inhalation of 1.5%-3.0% sevoflurane can not.