丙泊酚和七氟醚对耳鼻咽喉手术患者一氧化氮代谢影响的比较

Effects of propofol and sevoflurane on levels of nitric oxide in plasma and erythrocyte during ear-nosethroat surgery

目的观察丙泊酚和七氟醚麻醉耳鼻咽喉手术患者红细胞和血清中一氧化氮（NO）、亚硝酸盐（NO-2）、硝酸盐（NO3-）含量的变化。方法 18例择期行耳鼻咽喉手术患者,男13例,女5例,年龄18~52岁,体重51~100kg,随机均分为丙泊酚（P组）和七氟醚（S组）,麻醉诱导P组采用咪达唑仑0.06mg/kg、舒芬太尼0.5μg/kg、丙泊酚2mg/kg、阿曲库铵0.15mg/kg,S组采用吸入浓度3%~5%的七氟醚,余同P组。麻醉维持P组泵注丙泊酚6~8mg·kg-1·h-1和瑞芬太尼0.05~0.10μg·kg-1·min-1,S组泵注等量的瑞芬太尼和吸入挥发罐浓度为1.5%~2.0%的七氟醚。检测诱导前和麻醉后2h血清和红细胞中NO、NO-2、NO-3和黄嘌呤氧化酶（XOD）的浓度及变化。结果与诱导前比较,P组和S组麻醉后2h红细胞NO和XOD浓度明显升高（P〈0.05）,同时NO-3和NO-2浓度明显降低（P〈0.05）,血清中NO、NO-2和NO-3水平均明显降低（P〈0.05）,XOD水平均明显增加（P〈0.05）。与P组比较,S组麻醉后2h血清中NO、NO-3水平明显降低（P〈0.05）。红细胞中,两组诱导前以及S组麻醉后2hNO与XOD呈明显线性相关。结论耳鼻咽喉手术全麻患者术中红细胞NO生成增加,丙泊酚比七氟醚影响显著;而血清NO降低,七氟醚比丙泊酚影响显著,其机制可能与XOD的增加有关。

Objective To explore the effects of propofol and sevoflurane on the nitrate-nitrite- nitric oxide pathway during ear-nose-throat surgery. Methods Eighteen patients, including male 13 and female 5, aged 18-52 years old, weighing 51-100 kg, undergoing elective ear-nose-throat surgery with general anesthesia were enrolled in the study during general anesthesia. They were randomly al- located to two groups. Group P was induced with midazolam 0. 06 mg/kg, sufentanil 0.5 μg/kg, propofol 2 mg/kg and atracurium 0. 15 mg/kg,while group S with 3%--5% sevoflurane and the same dosage of midazolam, sufentanil, atracurium. Group P was maintained with profofol 6-8 mg · kg-1 · h-1 and remifentanil 0.05-0. 10 μg · kg-1 μ min-1 while group S with 1.5%-2.0% sevoflurane. The level of nitric oxide （NO）, nitrite, nitrate and xanthine oxidase （XOD） in erythrocytes and plasma were measured before induction and 2 hours after anesthesia. Results The erythrocytes concentration of NO and XOD at 2 h after anesthesia were significantly higher than that before induction（P〈0.05）, and NO3, NO2- were lower （P〈0. 05） ;The serum concentration of NO, NO2- and NO3 at 2h after anesthesia were lower than those before induction（P〈0.05）, and XOD was higher at 2h after anes- thesia（P（0. 05）. Compared with group P, NO and NO3 2 h after anesthesia were decreased in group S （P〈0. 05）. There was significant positive linear correlation between NO and XOD in the two groups before induction, and in group S 2 h after anesthesia. Conclusion Propofol and sevoflurane modified NO, nitrate, nitrite and XOD level after anesthesia. The mechanisms may relate to the effects of propofol and sevoflurane on the nitrate-nitrite-nitric oxide pathway.