BIS监测下小剂量咪达唑仑联合丙泊酚靶控输注的麻醉诱导效果及RAAS系统活性

Anesthesia induction effect and RAAS system activity of low-dose midazolam combined with target-controlled propofol infusion under BIS monitoring

目的:研究BIS监测下小剂量咪达唑仑联合丙泊酚靶控输注的麻醉诱导效果及肾素-血管紧张素-醛固酮系统(RAAS)活性。方法:选择2012年4月~2015年12月在我院接受择期全麻手术的40例患者,随机分为对照组(C组)和小剂量咪达唑仑组(M组),评估丙泊酚靶控输注血浆浓度的EC5 0,测定诱导前和诱导完成后血浆中一氧化氮(NO)、亚硝酸盐(NO_2^-)、硝酸盐(NO_3^-)、黄嘌呤氧化酶(XOD)、肾素(PRA)、血管紧张素-Ⅱ(ANG-Ⅱ)、醛固酮(ALD)的浓度。结果:M组丙泊酚的EC5 0显著低于C组(P<0.05);麻醉诱导前和诱导完成后,M组平均动脉压、动脉血氧分压、动脉血二氧化碳分压、中心静脉压与C组比较无显著性差异(P>0.05);麻醉诱导完成后,C组血浆NO、NO_2^-、NO_3^-、XOD含量显著低于麻醉诱导前(P<0.05),PRA、ANG-Ⅱ、ALD的浓度显著高于麻醉诱导前(P<0.05),M组血浆NO、NO_2^-、NO_3^-、XOD、PRA、ANG-Ⅱ、ALD含量与麻醉诱导前无显著性差异(P>0.05);M组麻醉诱导后的血浆NO、NO_2^-、NO_3^-、XOD含量显著高于C组(P<0.05),PRA、ANG-Ⅱ、ALD的浓度显著低于C组(P<0.05)。结论:BIS监测下小剂量咪达唑仑联合丙泊酚靶控输注的麻醉效果确切且能够减少丙泊酚用量、抑制RAAS系统激活。

Objective：To study the anesthesia induction effect and RAAS system activity of low-dose midazolam com- bined with target-controlled propofol infusion under BIS monitoring. Methods： A total of 40 patients undergoing selective gener- al anesthesia surgery in our hospital between April 2012 and December 2015 were selected and randomly divided into control group （group C） and low-dose midazolam group （group M）, plasma concentration EC50 of target-controlled propofol infusion was assessed, and the plasma concentrations of NO, NO2-, NO3-, XOD, PRA, ANG-Ⅱ and ALD were determined before and after induction. Results： Propofol EC50 of group M was significantly lower than that of group C; before and after anesthesia induction, mean arterial pressure, arterial partial pressure of oxygen, arterial partial pressure of carbon dioxide and central ve- nous pressure of group M were not significantly different from those of group C （P〉0.05） ; after anesthesia induction, NO, NO2-, NO3- and XOD content in plasma of group C were significantly lower than those before anesthesia induction （ ＊ P 〈0.05）while PRA, ANG-Ⅱ and ALD concentration were significantly higher than those before anesthesia induction （ ＊ P〈0.05） ,and NO, NO2-, NO3-, XOD, PRA, ANG-Ⅱ and ALD content in plasma of group M were not significantly different from those before anesthesia induction （P〈0.05）; NO, NO2-, NO3 and XOD content in plasma of group M after anesthesia induction were significantly higher than those of group C （ # P〈0.05） while PRA, ANG- Ⅱ and ALD concentration were sig- nificantly lower than those of group C （ # P〈0.05）. Conclusions： Low-dose midazolam combined with target-controlled propo- fol infusion under BIS monitoring is with exact anesthetic effect and can reduce the dosage of propofol and inhibit the activation of RAAS system.