异丙酚/七氟醚麻醉诱导气管插管对患者血浆血管加压素和内皮素变化的影响

EFFECT OF INTUBATION AFTER PROPOFOL/SEVOFLURANE ANESTHETIC INDUCTION ON THE PLASM ARGININE VASOPRESSIN AND ENDOTHELIN

目的 :观察异丙酚 /七氟醚麻醉诱导管插管时患者血浆血管加压素 (argininevasopressin ,AVP)和内皮素(endothelinET)变化及其与应激反应的关系。方法 :选择 18例ASAⅠ～Ⅱ择期上腹部手术的成年患者给异丙酚 2mg/kg ,待病人入睡后面罩吸氧 ,并吸入 4%～ 5 %七氟醚 ,辅助通气 15min以上 ,咽喉部充分表麻后喉镜暴露声门并插入气管导管 ,观察诱导前、喉镜暴露前、插管后即刻收缩压 (SBP)、平均动脉压 (MAP)、心率(HR)、AVP、ET等各指标的值 ,并进行统计分析。结果 :插管后即刻与喉镜暴露前相比SBP、MAP、HR和AVP均极显著升高 (P <0 .0 1) ,但AVP含量的升高值与MAP的升高值的相关系数r =0 .2 2 8(P >0 .0 5 ) ;诱导前、喉镜暴露前与插管后即刻血浆ET的含量无显著变化 (P >0 .0 5 )。结论 :AVP可作为一种急性应激反应的敏感指标之一 。

Objective:To investigate the relationship between the changes of patient plasma arginine vasopressin (AVP) and endothelin (ET) with stress during intubation after Propofol/Sevoflurane anesthetic induction.Methods:18 grade Ⅰ～Ⅱpatients scheduled for elective upper abdominal surgery,were selected.After Propofol 2mg/kg were slowly given by intravein,Oxygen plus 4～5% Sevoflurane was inhaled by mask and respiration were performed about 15min later,the values of SBP,HR,AVP and ET at the time of pre-induction,pre-laryngoscopy and post-intubation were selected.The statistic analysis were t-test for dependent samples and simple correlation.Results:The post-intubation values of SBP,MAP,HR,AVP were all significantly increased compared with that of pre-laryngoscopy(P<0.01),but the pearson product-moment correlation coefficient were not statistically significant(r=0.228,P>0.05);the values of ET didn't change significantly at the time of pre-induction,pre-laryngoscopy and post-intubation(P>0.05).Conclusions:AVP may be regard as one of sensitive indicators to acute stress,ET maynot be sensitive to acute stress.