不同麻醉方法对术中唤醒试验患者应激反应的影响

Effects of Different Anesthetic Methods on Patients′ Stress Reaction in Intraoperative Wake-up Test

目的比较不同麻醉方法对术中唤醒试验患者应激反应的影响。方法 60例行脊柱侧凸矫正术患者按随机数字表法分为丙泊酚+瑞芬太尼静脉麻醉组(A组)、七氟醚+瑞芬太尼麻醉组(B组),每组30例。唤醒前30 min停止静注阿曲库铵,唤醒前10 min,A组停止输注丙泊酚和瑞芬太尼,B组停止吸入七氟醚和瑞芬太尼。记录两组病人停用丙泊酚、瑞芬太尼和七氟醚时(T1)、唤醒即刻(T2)、加深麻醉后15 min(T3)时的心率(HR)、平均动脉压(MAP)、血糖及血浆皮质醇浓度,观察两组的唤醒时间和苏醒质量。结果两组唤醒时间分别为(11.2±1.3)min和(10.7±2.1)min,差异无统计学意义(P>0.05)。A组苏醒质量优于B组(P<0.05)。两组唤醒即刻的HR、MAP、血糖及血浆皮质醇浓度均高于唤醒前(P<0.05),但各时点A组上述指标均低于B组(P<0.05)。结论丙泊酚+瑞芬太尼全凭静脉麻醉行脊柱侧凸矫正术,患者术中唤醒时应激反应程度低于七氟醚+瑞芬太尼静吸复合麻醉。

Objective To compare the effects of different anesthetic methods on patients＇ stress reaction in intraoperative wake-up test. Methods Sixty patients undergoing scoliosis surgery were scheduled into two groups randomly： intravenous anesthesia with propofol ＋ remifentanil （ Group A, n = 30 ）, anesthesia with sevoflurance ＋ remifentanil （Group B, n = 30）. The injection with atracurium was stopped 30 min before patients＇ wake-up in both groups, then the injection with propofol and remifentanil was stopped 10 min before patients＇ wake-up in Group A,while the injection with sevoflurance and remifentanil was stopped in Group B. Heart rate（HR） ,mean arterial pressure（MAP）,blood glucose and plasma cortisol concentration were recorded at the following time points：T1 ：the time of stopping propofol,remifentanil and sevoflurance;Tz：wake-up time;T3：15 min after deeper anesthesia; and the wake-up time and analepsia quality were observed. Results There was no significant difference between two groups in the wake-up time[ （11.2 ± 1.3）min vs （ 10.7 ± 2. 1 ） min, P 〉 0.05 ]. The analepsia quality in Group A was superior to that in Group B （ P 〈 0.05 ）. HR, MAP,blood glucose and plasma cortisol concentration at T2 were all higher than those at T1 in both groups（P 〈0.05）. But HR, MAP, blood glucose and plasma cortisol concentration of Group A at T1 or T2 or T3 were all lower than those of Group B （P 〈 0.05 ）. Conclusion In the intraoperative wake-up test, the degree of stress reaction of patients receiving intravenous anesthesia with propofol and remifentanil is lower than that of patients receiving remifentanil and sevoflurance anesthesia during scoliosis surgery.