术中持续静脉输注艾司洛尔改善妇科腹腔镜手术患者应激反应

Continuous esmolel infusion ameliorate stress reaction in patients undergoing gynecological laparoscopic surgery

目的探讨在妇科腹腔镜术中持续静脉输注艾司洛尔改善患者应激反应和稳定血流动力学的疗效。方法气管插管全身麻醉下行妇科腹腔镜手术的患者60例,随机分为3组,每组20例:Ⅰ组术中避免使用血管活性药物,常规输液至手术结束;Ⅱ、Ⅲ组在麻醉诱导的同时予艾司洛尔0.3mg/kg静脉注射,然后分别以50或100μg·kg-1·min-1的速率持续静脉输注艾司洛尔直至手术结束。3组麻醉维持均采用舒芬太尼和丙泊酚持续静脉注射。测定并记录麻醉诱导前(T0)、气管插管即刻(T1)、气腹后15min(T2)和手术结束时(T3)的平均动脉压(MAP)和心率(HR),以及血浆去甲肾上腺素(NE)、肾上腺素(E)、皮质醇和血糖值。结果与同组的T0时间点比较,Ⅰ组在T1至T3时间点的MAP、HR、NE和E显著升高(P值均<0.05)。Ⅱ和Ⅲ组在T1至T3时间点的MAP和HR较Ⅰ组同时间点显著降低(P值均<0.05),并且Ⅲ组在T2和T3时间点的MAP及T3时间点的HR较Ⅱ组同时间点显著下降(P值均<0.05)。除Ⅲ组T3时间点的血浆NE和E较同组T0时间点显著降低外(P值均<0.05),Ⅱ和Ⅲ组术中的血浆NE和E与同组T0时间点的差异均无统计学意义(P值均>0.05)。3组气腹后皮质醇均显著升高(P值均<0.05),其中Ⅰ组显著高于Ⅱ和Ⅲ组(P值均<0.05)。3组血糖值在气管插管后均显著升高(P值均<0.05),但组间差异均无统计学意义(P值均>0.05)。结论术中持续静脉输注艾司洛尔可有效改善妇科腹腔镜术中的应激反应。与较大的静脉输注速率(100μg.kg-1.min-1)相比,较小的静脉输注速率(50μg·kg-1·min-1)对维持血流动力学的平稳更为安全有效。

Objective To determine the effect of continuous infusion of esmolel in ameliorating stress reaction and stabilizing hemodynamics in patients undergoing gynecological laparoscopic surgery. Methods Sixty patients scheduled for gynecological laparoscopic surgery under general anesthesia with tracheal intubation were randomly divided into three groups （n=20 each）： groupⅠ, saline was infused regularly till the end of operation, avoiding administrating any vasoactive drug; group Ⅱ and Ⅲ, 0.3 mg/kg of esmolol was intravenous injected before anesthesia induction and then given continuous infusion at 50 μg·kg-1·min-1 （group Ⅱ） or 100 μg·kg-1·min-1 （group Ⅲ） till the end of operation. Sufentanil and propofol were continually intravenous infused tor maintain anesthesia in all the three groups. At the following time points： pre-induction （T0）, intubation （T1）, 15 min after pneumoperitoneum （T2） and the end of operation （T3）, mean arterial pressure （MAP）, the heart rates （HR） were measured and recorded, and plasma levels of norepinephrine （NE）, epinephrine （E）, cortisol （Cor）, and glucose （Glu） were detected as well. Results Compared to T0, MAP, HR, NE and E at T1, T2 and T3 were increased significantly in group Ⅰ （P〈0.05）, while MAP and HR at the same time points were decreased significantly in group Ⅱ and Ⅲ. Moreover, MAP at T2 and T3 and HR at T3 were decreased significantly in group Ⅲ compared with the corresponding values in group Ⅱ （P〈0.05）. NE and E in both group Ⅱand Ⅲ had no differences （P〈0.05） during the operation except for that at the end of the operation in group Ⅲ （lower than pre-induction, P〈0.05）. Plasma level of Cor was increased in all groups after pneumoperitoneum and Cor was higher in group Ⅰ than those in group Ⅱand Ⅲ （both P〈0.05）. Plasma level of glucose was increased significantly after intubation in all the three groups （all P〈0.05）, but there was no significent difference among different groups （all P〈0.05）. Conclusion Continuous infusion of esmolel in patients undergoing gynecological laparoscopic surgery can effectively ameliorate stress reaction during the operation. Compared to the high infusion rate （100 μg·kg-1·min-1）, administration of lower infusion rate （50 μg·kg-1·min-1） may be better for the stabilizing hemodynamics.