七氟烷与丙泊酚对冠心病患者上腹部手术围麻醉期应激反应作用的比较(1)
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【摘要】 目的 比较冠心病患者上腹部手术中七氟烷与丙泊酚对围麻醉期应激反应抑制的效果。方法 选择择期行胃大部切除术的冠心病患者40例，随机分为七氟烷+瑞芬太尼(SR组，n=20)和丙泊酚+瑞芬太尼(PR组，n=20)组。记录术中血管活性药物使用情况。术前，术后即刻，术后6,12,24 h抽取颈内静脉血测定C反应蛋白(CRP)，皮质醇和AtⅡ浓度。结果 应激反应指标皮质醇，CRP，AtⅡ术前无明显差异，术后即刻，术后6,12,24 h数据显示SR组低于PR组。结论 七氟烷复合瑞芬太尼比丙泊酚复合瑞芬太尼麻醉对冠心病患者上腹部手术具有更好的应激反应抑制效果。
【关键词】
七氟烷；丙泊酚；应激反应；皮质醇；C反应蛋白
Sevoflurane and Propofol on upper abdominal surgery in patients with coronary heart disease around the role of stress response during anesthesia compared
CONG Li, WANG Ling, SUN Lixin,et al.
Department of Anesthesiology, Eastern Hospital of Qingdao Municipal Hospital,Qingdao 266071,China
【Abstract】 Objective
To compare Sevoflurane and Propofol for abdominal surgery on patients with coronary heart disease in the stress response dampening effect. Methods 40 patients with coronary heart disease, elective gastrectomy were randomly divided into Sevoflurane + Remifentanil (SR group, n=20) and Propofol + Remifentanil (PR group, n=20) groups. Observed the hemodynamic parameters and recorded theuse of vasoactive drugs during intraoperative. Determination of Creactive protein serum (CRP), cortisol, and At Ⅱ concentration. Results Hemodynamic differences in the two groups of patients was not significant.Stress response index Cortisol, CRP, At Ⅱ no significant difference in preoperative.Immediately after operation, after 6,12,24 h data were lower SR group than in PR group. Conclusion Sevoflurane Remifentanil than Propofol remifentanil anesthesia for upper abdominal surgery in patients with coronary heart disease has a better inhibitory effect of the stress response.
【Key words】
Sevoflurane; Propofol; Stress response; Cortisol; CRP
作者单位：266071青岛市市立医院东院麻醉科
1 资料与方法
1.1 一般资料
选择冠心患者拟在全麻下行腹部手术40例，ASRAⅡ~Ⅲ级，年龄在65～85岁。男22例,女18例。ASA分级Ⅱ或Ⅲ级,全部合并有冠心病(心肌缺血),病史3～10年。心肌缺血的诊断方法与标准主要依靠心电图中ST段和T波的改变。诊断标准[1]。①ST段上升或降低1 mV。②在无Q波的导联、ST段上升>1.5 mv。③T波倒置或低平。所有患者术前均接受内科系统治疗,至T波、ST基本恢复正常。随机分为两组，每组20例：丙泊酚组(PR组)和七氟烷组(SR组)。
1.2 麻醉方法
两组患者麻醉前30 min肌内注射吗啡5 mg、东莨菪碱0.3 mg，两组诱导均采用咪唑安定0.03 mg/kg，依托咪酯0.3 mg/kg，芬太尼4 μg/kg，维库溴胺0 ......
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