慢性颅内高压病人麻醉中与气管插管时的应激反应

Stress responses during anesthesia and trackeal intubation in patients with chronic intracranial hypertension

目的研究慢性颅内高压病人麻醉中与气管插管时的应激反应。方法 ４３例择期开颅手术病人。２５例慢性颅内高压（ＣＩＣＨＴ），１８例颅压正常（ＮＩＣＰ）。分别用荧光光度和放免法测定诱导前、诱导后、插管后１、５、１０、１５、２５分钟血浆儿茶酚胺（ＣＡ；ＮＥ，Ｅ）和血清皮质醇（Ｃｏｒ）的水平，同时记录ＳＰ、ＤＰ、ＭＡＰ、ＨＲ及ＣＶＰ。结果两组在插管时均有显著的心血管反应，但ＣＩＣＨＴ组该反应的持续时间明显短于 ＮＩＣＰ组，且在插管后 １０、１５分钟 ＳＰ分别下降 ２８％和 ４２％（Ｐ＜０． ０１）， １４例（５６％）因低血压需要用麻黄碱治疗。血浆ＮＥ和Ｅ水平诱导前ＣＩＣＨＴ组即明显低于ＮＩＣＰ组（Ｐ＜０．０５），插管后５分钟内两组均升高（Ｐ＜０．０１），但ＣＩＣＨＴ组在插管后１０、１５分钟明显下降，且低于诱导前水平（Ｐ＜０．０５～０．０１）。血清Ｃｏｒ水平诱导前ＣＩＣＨＴ组即明显低于ＮＩＣＰ组（Ｐ＜０．０５），插管后５分钟内ＮＩＣＰ组明显升高（Ｐ＜０．０５～０．０１），而ＣＩＣＨＴ组无明显改变并于１０、１５分钟明显下降，且低于诱导前水平。结论ＣＩＣＨＴ病人应激反应能力明显下降。

Objective To evaluate the stress responses during anesthesia and tracheal intubation in patients with chronic intracranial hypertension (CICHT). Methods Forty-three patients, 25 cases of CICHT, 18 cases of normal intracranial pressure (NICP) were scheduled for craniotomy. Plasma catecholamines (CA: NE, E), serum cortisol (Cor) levels and blood pressure (SP, DP, MAP), HR, central venous pressure(CVP) were measured immediately before and after induction of anesthesia, and 1, 5, 10, 15 and 25min after intubation. Results 1. There were significant increases in cardiovascular response to tracheal intubation in both groups, but the duration was shorter in group CICHT than that in group NICP. SP decreased by 28% and 42% 10 and 15 min after intubation respectively (P<0. 01) and in 14 patients(56%) ephedrine was given intravenously for the hypotension in group CICHT. 2. Before induction the plasma NE and E levels were significantly lower in group CICHT than those in group NICP(P<0. 05),increased markedly following the intubation in both groups (P<0.01), but in group CICHT decreased significantly 10 and 15 min after intubation as compared with those before induction (P<0.05-0. 01). 3. Before induction, serum Cor level significantly lower in group CICHT than in group NICP(P<0. 05), but significantly increased in group NICP(P<0.05-0.01) and unchanged in group CICHT 1 and 5min after intubation. Serum Cor levels were significantly lower 10 and 15min after intubation than those before induction in group CICHT (P <0.05-0. 01). Conclusion The ability of stress response is reduced in the patients with CICHP.