静注卡托普利降低安氟醚麻醉用于剖腹手术期间过度应激反应

Captopril attenuates stress response to surgery in patients under general anesthesia with enflurane

目的 探讨静注卡托普利降低安氟醚麻醉用于剖腹手术期间过度应激所致循环不良反应的效果及机制。方法 择期剖腹手术病人 4 0例 ,随机分为两组 ,每组 2 0例。常规插管 ,安氟醚麻醉。试验组麻醉诱导前 1 0min及切皮后 30min分别静注卡托普利 0 30～ 0 35mg/kg及 0 1 5～ 0 1 8mg/kg。于麻醉前 (基础值 )、插管、切皮、探查、缝皮后各 1min及术后 1h测定SBP、DBP、HR、心率 收缩压乘积 (RPP)及血浆去甲肾上腺素 (NE)、肾上腺素 (E)、一氧化氮 (NO)、内皮素 (ET)、血栓素B2(TXB2 )、6 酮 前列腺素F1α(6 keto PGF1α)的含量 ,计算NO/ET、TXB2 /PGF1α比值。结果 麻醉后 ,对照组BP、HR、RPP、NE、E及TXB2 /PGF1α较其基础值明显升高 ,NO/ET比值显著降低 (P <0 0 5或P <0 0 1 ) ;而试验组NO/ET于插管后 1min显著升高 (P <0 0 5 ) ,余指标无明显改变 (P >0 0 5 )。与对照组相比 ,试验组麻醉手术期间BP、HR、RPP、NE及E显著降低 ,NO/ET比值明显升高 ,插管和探查后 1min的TXB2 /PGF1α显著降低 (P <0 0 5或P <0 0 1 )。结论 静注卡托普利降低血浆NE、E的水平 ,改善NO/ET平衡 ,降低TXB2 /PGF1α比值 ,可有效地降低安氟醚麻醉剖腹手术期间过度应激的循环不良反应。

Objective To investigate the effects of intravenous captopril on hemodynamic stress response to surgery in patients under general anesthesia with enflurane.Methods 40 ASAⅠ Ⅱ patients undergoing selective surgery were randomly divided into two groups with 20 cases each.In testing group,captopril 0 30 0 35 mg/kg and 0 15 0 18 mg/kg were given at 10 min before induction and 30 min after skin incision respectively.BP,HR,ECG and SpO 2 were continuously monitored.Blood samples were taken from peripheral vein before intuction,at 1 min after intubation,skin incision, exploration, and skin suture,at 1 h after operation for determining plasma concentration of noradrenaline(NE),adrenaline (E),nitric oxide (NO),endothelin (ET),thrombo xaneB 2(TXB 2)and prostacyclin(6 keto PGF 1α ).Results In control group,BP,HR,RPP,NE,E and TXB 2/PGF 1α ratio increased significantly,and NO/ET ratio decreased markedly during anesthesia and surgery as compared with the baseline( P< 0 05 or P< 0 01).In testing group,NO/ET ratio increased significantly at 1 min after intubation as compared with the baseline( P< 0 05),and other markers remained unchanged during surgery( P> 0 05).In testing group,BP,HR,RPP,NE and E was decreased significantly,and NO/ET ratio was increased markedly during surgery,and TXB 2/PGF 1α ratio was decreased markedly at 1 min after intubation and skin incision as compared with those in control group( P< 0 05 or P< 0 01).Conclusion Intravenous injection of captopril may attenuate effectively the hemodynamic stress response to surgery under general anesthesia with enflurane.