异丙酚对气管切开插管应激反应的影响

Effects of Propofol on the Stress Response to Conscious Tracheotomy and Intubation

目的 :研究异丙酚对喉部手术气管切开插管期应激反应有无抑制作用。方法 :拟行喉部手术病人 40例 ,随机分成两组 :异丙酚组在切皮前静注异丙酚 1 5～ 2mg/kg后用微泵持续给药 6～ 8mg·kg-1·h-1至气管插管后 5分钟 ;对照组注入生理盐水 ,观察记录切皮前 (T1)、切管时 (T2 )、插管时 (T3 )及插管后 3(T4 )、5 (T5)、10分钟 (T6)病人SBP、DBP、HR、SpO2 及测定血浆去甲肾上腺素 (NE)、肾上腺素 (E)的浓度。结果 :对照组在T2～ 5时血中NE和E明显升高 (P <0 0 5 ) ,异丙酚组则无明显变化 (P >0 0 5 )。对照组的SBP、DBP、HR在T2 、T3 明显升高 (P <0 0 5 ) ,异丙酚组SBP在用药后即下降 (P <0 0 5 ) ,插管时升高接近于用药前水平。结论

Objective: To study prophylactic effects of propofol on the stress response to conscious tracheotomy and intubation.Methods:Fourty male patients scheduled for laryngeal operation were randomly divided into two groups:Group C(control) with saline 5ml,Group P(propofol) with a bolus of propofol 15～2mg/kg before skin incision followed by 6～8mg·kg -1 ·h -1 continous infusion until 5 min after intubation.Systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR)and pulse oxygen saturation(SpO 2) were recorded and plasma catecholamine concentrations were examined before skin incision(T 1),immediately after tracheal incision(T 2),immediately after intubation(T 3),at 3min(T 4),5min(T 5)and 10min(T 6) after intubation.Results:The levels of plasma norepinephrine and epinephrine in group C increased markedly at T 2～5 (P<005)while no significant changes in group P were found.The SBP,DBP,HR in group C increased significantly at T 2,3 (P<005),but SBP in group P decreased immediately(P<005) after administering propofol and increased nearly to the baseline at T 3. Conclusion:The results suggest that propofol can blunt effectively the stress response to conscious tracheotomy and intubation.