脑瘤手术中吸入异氟醚或异丙酚麻醉对血流动力学及应激反应的影响

Effects of inhalation of isoflurance or total intravenous of propofol anesthesia on hemodynamics and on the stress response during brain tumor resection

目的 研究两种麻醉方法对血流动力学和应激反应的影响。方法 行脑瘤手术的 38例病人随机分为两组 ,醚组和酚组 ,醚组 (2 0例 ,咪唑安定、芬太尼、万可松诱导 ;维持麻醉为吸入异氟醚 1MAC ,30min后 1.5MAC ,30min。间断静注芬太尼、万可松 ) ;酚组 (18例 ,诱导同醚组 ,维持麻醉为全凭异丙酚静脉泵入 6mg·kg 1 ·h 1 ,30min后 12mg·kg 1 ·h 1 ,30min。间断静注芬太尼、万可松 )。快速补液。两组分别于诱导前 (T1 )、插管后即刻 (T2 )、麻醉维持 30min(T3)和 6 0min(T4 ) 4个时动脉血测定血糖浓度。同时监测血流动力学。结果 (1)血流动力学变化 醚组 :MAP值在T3、T4 时点非常显著降低 (P <0 .0 1) ,且显著低于酚组同时点值 (P<0 .0 5 )。HR值各时点无统计学差异 (P <0 .0 5 ) ;酚组 :MAP值在T4 时点显著降低 (P <0 .0 5 )。HR值在T3、T4 时点显著降低 (P<0 .0 5 ) ,并低于醚组同时点值 (P <0 .0 5 )。 (2 )动脉血血糖浓度的变化 异丙酚组各时点血糖无变化 ;异氟醚组血糖浓度在麻醉后 30及 6 0min显著升高 (P <0 .0 5 ,P <0 .0 1)。结论 酚组的麻醉方式可适当控制应激反应 ,术中平稳 。

Objective To study effects of two anesthesia ways on hemodynamics and on the stress response.Methods Thirty eight patients undergoing brain tumor resection,were randomly divided into two groups:ISO.Group( n =20,inducated with midazolam?fentanyl and vecuronium,maintained with isoflurance 1MAC,30min followed by 1.5MAC,30min.and intravenous infusion of fentanyl?vecuronium discontinuously);PRO Group( n =18,inducated with same medicine as ISO.Group,maintined with continuous intravenous infusion of propofol 6mg.kg 1 ·h 1 ,30min followed by 12mg.kg 1 ·h 1 ,30min,and fentanyl?vecuronium were gaven discontinuously).Blood samples were taken form artery before anesthesia of inducation (T 1),right after intubation(T 2),after maintenance 30min(T 3) and 60min(T 4)to detemine concentration of glucose,At same time we monitored patients hemodynamics continuously.Results (1)ISO.Group:MAP at T 3 and T 4 were decreased very obviously,( P <0.01),and lower than that of PRO group at the same time points( P <0.05).At all time points,there were no significant changes of HR;PRO group:MAP at T 4 wre decreased obviously( P <0.05).HR at T 3 and T 4 were decreased obviously( P <0.05),and lower than that of ISO group at the same time points( P <0.05).(2)Blood concentrations of glucose were unchanged significantly in propofol group.In isoflurane group,however,bold concentration of glucose significantly increased at 30?60min,( P <0.05 and P <0.01).Conclusion Because of its function of moderate degree inhibition to the stress respones the anesthesia technique of PRO group is better for brain tumor resection.