七氟烷和丙泊酚全身麻醉对腹腔镜胆囊切除术中患者血流动力学的影响比较

Influence Comparison of Sevoflurane and Propofol Anesthesia on Hemodynamics in Laparoscopic Cholecystectomy

目的:观察七氟烷和丙泊酚全身麻醉对腹腔镜胆囊切除术中血流动力学的影响。方法:98例行腹腔镜胆囊切除术的患者随机分为P组、S组。P组患者采用丙泊酚进行麻醉,S组采用七氟烷进行麻醉。分别观察两组患者在麻醉前、插管2min后、插管10 min后、气腹5 min后、气腹30 min后及术毕患者的血糖、皮质醇的变化及血流动力学各项指标的变化情况,并观察两组患者术后的不良反应的发生情况。结果:两组患者在麻醉2 min、10 min后血糖均明显降低(P<0.05或0.01),气腹30 min及术毕血糖明显升高(P<0.01);且S组患者术毕的血糖值明显低于P组(P<0.01)。两组患者插管2 min时皮质醇较麻醉前均明显降低(P<0.05或0.01),P组患者在气腹5 min及术毕的皮质醇值均明显高于麻醉前(P<0.01),且气腹5min、30 min及术毕S组的的皮质醇值明显低于P组(P<0.01)。两组患者麻醉各时期HR、SPO2水平组内和组间比较,差异均无统计学意义(P>0.05)。两组患者在插管2 min、10 min后,SBP均出现明显降低(P<0.01),气腹5 min、30 min时,两组患者SBP比较,差异有统计学意义(P<0.01)。插管2 min、10 min时,两组患者的DBP均较麻醉前明显降低(P<0.01),两组间比较差异也有统计学意义(P<0.01);P组患者气腹5 min、30 min时DBP与S组比较,差异有统计学意义(P<0.05)。两组药品不良反应发生率差异无统计学意义(P>0.05)。结论:腹腔镜胆囊切除术患者采用七氟烷吸入麻醉,能维持患者血流动力学的稳定,麻醉效果优于丙泊酚。

Objective ： To observe the influence of sevoflurane and propofol anesthesia on hemodynamics in laparoscopic cholecys- tectomy. Methods： Totally 98 patients with laparoscopic cholecystectomy were randomly divided into P group and S group. P group was with propofol for anesthesia, and S group was with sevoflurane for anesthesia. Before anesthesia, 2rain after intubation, 10 min after intubation, 5min and 30min after pneumoperitoneum, and after the surgery, the levels of blood glucose and cortisol, and hemodynamic changes in the two groups were observed, and the incidence of adverse reactions was also studied. Results： 2 min and 10 min after the anesthesia, the blood glucose levels in the two groups were significantly lower than those before the anesthesia （ P 〈 0.05 or 0.01 ）, while 30 min after pneumoperitoneum and after the operation, the blood glucose levels were increased（ P 〈 0. 01 ）. The blood glucose levels in S group after the operation were much iower than those in P group （ P 〈 0.01 ）. 2 min after intubation, cortisol was decreased in the two groups （P 〈 O. 05 or 0.01 ）. 5 min after pneumoperitoneum and after the operation, cortisol levels were higher than those before the anesthesia in P group（P 〈 0. 01 ）, and 5 rain and 30 rain after pneumoperitoneum and after the operation, cortisol levels in S group were lower than those in P group （P 〈 0. 01 ）. HR and SPO2 showed no significant changes in the two groups during the whole process （P 〉 0. 05 ）. 2 min and 10 min after intubation, SBP in the two groups was decreased （P 〈 0.01 ）, and 5 rain and 30 min after pneumoperitoneum, there was notable difference in SBP between the groups （P 〈 0.01 ）. 2 min and 10 rain after intubation, DBP was decreased in the two groups （ P 〈0.01 ）, and the difference was significant between the groups （P 〈0. 01 ）. 5 min and 30 min after pneumoperitoneurn, DBP in P group had notable difference with that in S group （ P 〈 0. 05 ）. The incidence of adverse reactions in the two groups showed no significant difference （p 〉 0. 05 ）. Conclusion： Sevoflurane anesthesia in laparoscopic cholecystectomy can keep stable hemodynamics in the patients, and the anesthetic effect is better than propofol.