全凭静脉麻醉对老年食道癌手术病人应激反应的影响

EFFECT OF TOTAL INTRAVENOUS ANESTHESIA FOR THE STRESS REACTION ON OLD PATIENT SUFFERING FROM ESOPHAGEAL CARCINOMA

目的:应用血浆靶控输注技术探讨全凭静脉麻醉与静吸复合全麻两种不同麻醉方法对老年食道癌手术病人应激反应的影响。方法:60例老年食道癌手术病人随机分为血浆靶控全凭静脉麻醉组(A组30例)和静吸复合全麻组(B组30例)。麻醉诱导插入气管导管后,麻醉维持A组:丙泊酚血浆靶浓度2.0～3.0μg/mL,瑞芬太尼血浆靶浓度1.5～2.0μg/mL;B组:吸入1.5～2%的异氟醚,间断注入芬太尼0.05mg/次。两组均监测脑电双频指数(BIS),通过调整A组静脉麻醉药的给药输注速度及B组吸入异氟醚的浓度,使BIS维持在45～50。常规连续监测平均动脉压(MBP)、心率(HR)、中心静脉压(CVP)、脉搏血氧饱和度(SpO2)及呼气末二氧化碳分压(PetCO2)。分别于麻醉诱导前(T1)、手术2h(T2)、术毕(T3)、术后24h(T4)采静脉血,测定血浆去甲肾上腺素(NE)、皮质醇(COR)、C-反应蛋白(CRP)、血糖(Glu)。结果:两组间T1各项指标无差异,随着手术的进展A组各时点NE、CRP明显低于B组(P<0.05),A组T2、T3的COR、Glu浓度也明显低于B组(P<0.05)。结论:手术刺激会使病人的应激反应增强,两组的麻醉深度一致,但血浆靶控全凭静脉麻醉组引起的应激反应比静吸复合全麻组小,循环稳定,血浆靶控全凭静脉麻醉是老年食道癌根治术比较理想的麻醉方法。

Objective：To observe the influence of different anesthesia patterns（total intravenous anesthesia and intravenous combined with inhalation anesthesia）on the tress response of the elder with esophageal carcinoma.Methods：60 cases of elderly patients with esophageal carcinoma were randomly divided into two groups A and B.Group A was total intravenous anesthesia by TCI（30 cases）.Group B was intravenous combined with inhalation anesthesia（30 cases）.After the same induction of anesthesia.Group A：target plasma concentration of propofol at 2.0~3.0ug/mL and fentanyl at 1.5~2.0μg/mL for the maintenance of anesthesia.Group B inhale isoflurane 1.5~2.0% and injecx fentanyl 0.05mg per time intermittently.During the two groups’ operation,monitor bispectral and maintain it between 45~50 by adjusting the infusion rate of propofol and remifentanil in group A and inhalate adequate concentration of isoflurane in group B.Then to monitor MBP,HR,SpO2 and CVP conventionally.Vein blood samples were obtained before induction of anesthesia（T1）,at 2h in surgery（T2）,at the end of surgery（T3）,at 24h after surgery（T4）for determination of the plasma level of norepinephrine（NE）,cortisol（COR）,C-reactive protein（CRP）and blood glucose（Glu）.Results：There was no significant difference in all index level at T1 between the two groups.Along with the operation NE and CRP were significantly lower at the last there times In groups A than in Group B（P〈0.05）.COR and Glu were also significantly lower at T2 and T3 In groups A than in Group B（P〈0.05）.Conclusion：Surgery will increase the patient’s stress response.But stress response was lighter and circulation was steadier in total intravenous anesthesia by TCI than in intravenous combined with inhalation anesthesia.so total intravenous anesthesia by TCI is an ideal method for surgery of elderly patients with esophageal carcinoma.