全身麻醉对上腹部手术患者血浆内皮素和心钠素的影响

EFFECTS OF COMBINED ANESTHESIA AND TOTAL INTRAVENOUS ANESTHESIA ON ENDOTHELIN AND ATRIAL NATRIURETIC PEPTIDE IN PATIENTS UNDERGOING UPPER ABDOMINAL SURGERY

目的 :观察全身麻醉对上腹部手术患者血浆内皮素 (ET)和心钠素 (ANP)的影响。方法 :择期上腹部手术患者 2 0例 ,随机分 2组 ,Ⅰ组为静吸组 ;Ⅱ组为静脉组。诱导后Ⅰ组吸入异氟醚 ,Ⅱ组输注丙泊酚维持麻醉。于麻醉前、诱导后、手术10min、手术 5 0min及术毕采静脉血 ,用放免法测定血浆ET和ANP的含量。结果 :①ET在Ⅰ组手术 10min时下降 ,5 0min及术毕显著下降 (P均 <0 .0 1) ;而Ⅱ组无明显变化。ANP在Ⅰ组手术 5 0min明显下降 (P <0 .0 5 ) ;Ⅱ组术毕却明显升高 (P <0 .0 5 )。②一秒呼出率 (FEV1)在Ⅰ组手术 10min及 5 0min显著增加 (P均 <0 .0 5 ) ,Ⅱ组却无明显变化。结论 :静吸复合麻醉比全凭静脉麻醉可能更适合于气道高反应患者。

Objective:To observe the effects of anesthesia on levels of plasma ET and ANP in the patients undergoing upper abdominal surgery.Methods:Twenty patients,undergoing elective upper abdominal surgery,were randomly divided into two groups.Anesthesia was both induced with same drugs.After intubation,1.0MAC isoflurane was inhaled and maintained in groupⅠ,while propofol 60～70μg/(kg·min) was continuely pumped in groupⅡ.Venous samples were taken at five time points before anesthesia,after induction,at 10min and 50min after incision and at the end of surgery contents of ET and ANP were measured by radioimmumoassay.Results:①The levels of plasma ET had no statistical difference in group Ⅱ,but it significantly decreased at 10min after incision and even more at 50min after incision and at the end of surgery in group Ⅰ(P<0.01). The levels of plasma ANP decreased markedly at 50 min after incision in group Ⅰ(P<0.05),but it was significantly greater at the end of surgery in group Ⅱ(P<0.05).②FEV1 was significantly elevated at 10min and 50min after incision in group Ⅰ(P<0.05).Conclusions:Combined anesthesia could be a better choice than total intravenous anesthesia for the patients with airway hyperreactivity.