异丙酚不同靶控输注方式对全麻诱导阶段血浆中皮质醇、催乳素的影响
药物投予系统,,异丙酚；,药物投予系统；,皮质醇；,催乳素,1资料与方法,2结果,3讨论,参考文献：
摘要：目的：观察异丙酚不同输注方式对麻醉诱导阶段血浆皮质醇(Cor)、催乳素(PRL)及心血管系统的影响。方法：30例择期全麻手术患者，根据诱导时输注方式的不同随机分为G1(国人参数靶控输注)、G2(Tackley参数靶控输注)、G3(人工模拟靶控输注)组，每组10例，分别于诱导前(T0)、轻拍三角肌无反应即刻(T1)、气管插管过声门即刻(T2)、气管插管后3 min(T3)、5 min(T4)、10 min(T5)时点监测和记录心率(HR)、平均动脉压(MAP)，并测定3组血浆Cor、PRL的浓度。结果： 3组麻醉诱导期间HR、MAP随时间变化差异均无统计学意义(P>0.05)。G2、G3组在T1时点HR均较T0时点升高，G3组MAP在T2时点较T0时点有明显升高(P<0.05)， 3组异丙酚麻醉诱导阶段Cor、PRL的浓度差异有统计学意义(P<0.01)。结论：国人参数靶控输注(G1)组对控制气管插管所致的应激反应要优于Tackley参数靶控输注(G2)组、人工模拟靶控输注(G3)组。麻醉诱导期间血浆Cor、PRL浓度变化可能用于判定镇静深度。关键词： 异丙酚； 药物投予系统； 皮质醇； 催乳素
A randomized study on the influence of different target controlled propofol
delivery systems on plasma concentration of cortisol and
prolactin during induction of general anesthesia
ZHENG Hong, FANG Mei, CAO Xinghua, et al
(Department of Anesthesiology, First Affiliated Hospital, Xinjing Medical University, Urumqi 830054, China)
Abstract: Objective: To study the influence of different target controlled propofol delivery systems on plasma concentration of cortisol and prolactin during induction of anesthesia. Methods: Thirty ASA Ⅰ~Ⅱ patients (17 male, 13 female) aged between 20~60 yr scheduled for surgery under general anesthesia were included in this study. Body weight ranged 45~80 kg. According to the ways of propofol given by different intravenous delivery system during induction of anesthesia, the patients were randomly divided into three groups of 10 each: (G1) the Chinese pharmacokinetic model and parameters group and (G2) the pharmacokinetic model and parameters by Tackley group as well as (G3) BET group of which the TCI system was set up by manual infusion using Graseby 3 500 infusion pump and 3 μg/ml target plasma concentration of propofol was obtained by three steps (10/8/6). As soon as the level of sedation was assessed by no response to prodding(OAA/S≤2) intubation was facilitated with fentanyl 2 μg/kg and vecuronium 0.1 mg/kg intravenously. All patients were unpremedication. Radial artery was cannulated for blood sampling. MAP and HR were continuously monitored during induction of anesthesia. Blood samples were taken before induction of anesthesia (T0 baseline), after no response to prodding (T1), immediately intubation(T2), 3 minutes after intubation(T3), 5 minutes after intubation(T4), and 10 minutes after intubation(T5) to measure plasma concentration of cortisol and prolactin. Meanwhile MAP and HR values were recorded at time of blood sampling. Results: During induction of anesthesia, the changes of HR and MAP over time have no significant difference among three groups (P>0.05). The changes of cortisol and prolactin over time have significant difference among three groups (P<0.01). At the endpoint of T1, the concentration of prolactin was slightly increased, however the concentration of prolactin was decreased in three groups. The level of cortisol and prolactin were elevated at the time of intubation in three groups, which was less pronounced in the G1 but markedly in the G3. Conclusions: The three target controlled propofol delivery systems have been shown to blunt the hemodynamic and stress response to laryngoscopy. The G3 group was superior to the other two groups in controlling stress response. The plasma concentration of cortisol and prolactin would be better to predict the depth of sedation. ......
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