七氟醚静吸复合麻醉对腹腔镜胆囊切除术中患者应激反应的影响

Effect of sevoflurane inhalation anesthesia on stress reaction in the elderly patients undergoing laparoscopic cholecystectomy

目的:探讨腹腔镜胆囊切除术中采用七氟醚静吸复合麻醉对老年患者应激反应。方法:60例拟行腹腔镜下胆囊切除(LC)的患者分为七氟醚组和丙泊酚组。七氟醚组采用七氟醚吸入和静脉泵入雷米芬太尼麻醉,丙泊酚组采用丙泊酚靶控输注和静脉泵入雷米芬太尼麻醉。分别于麻醉诱导前10min(T1)、诱导后10min(T2)、气腹后30min(T3)、气腹后60min(T4)和术后30min(T5)测定血浆肾上腺素(AD)、去甲肾上腺素(NE)和皮质醇含量。结果:两组T1和T2时血浆AD、NE和皮质醇含量无明显差异(P>0.05)。与T1时比较,两组在T3～T5三个时点血浆AD、NE含量均显著下降(P<0.05),皮质醇含量显著上升(P<0.05),且在T3～T5三个时点,七氟醚组血浆AD、NE和皮质醇含量与丙泊酚组比较显著下降(P<0.05)。结论:对老年LC手术患者七氟醚静吸复合麻醉可抑制交感神经兴奋,减轻机体的应激反应。

Objective： To evaluate the effect of sevoflurane inhalation anesthesia on stress reaction in the elderly patients undergoing laparoscopic cholecystectomy （LC）. Methods： 60 cases of patient proposed LC surgery were divided into sevoflurane group and propofol group. The sevoflurane group was given the anesthesia of the sevoflurane inhalation combined with intravenous infusion remifentanil, and the propofol group was given the anesthesia of target-controlled infusion （TCI） of propofol combined with intravenous infusion remifentanil. The plasma adrenaline,epinephrine （AD）, norepinephrine （NE） and cortisol levels of two groups were detected 10 min before anesthesia induction（T1）, 10min after induction（T2）, 30min after pneumoperitoneum （T3）, 60min after pneumoperitoneum （T4） and 30min after operation （T5）. Results： The plasma AD, NE and cortisol levels of the two groups were no significantly different at T1and T2 （P〉 0.05）. Compared with these at T1,at T3 to T5 the plasma AD and NE levels of the two groups decreased significantly （P 〈0.05）, the plasma cortisol level increased significantly （P 〈0.05）, and at T3 to T5 the plasma AD, NE and cortisol levels of the sevoflurane group decreased significantly, compared with the propofol group the difference was significant （P 〈0.05）. Conclusion： The sevoflurane inhalation anesthesia can suppress the sympathetic excitation and reduce the stress response in the elderly patients undergoing LC.