摘要
目的研究丙泊酚和硝普钠控制性降压对机体应激反应的影响。方法ASAⅠ～Ⅱ级择期耳鼻喉显微外科手术病人 30例 ,随机分两组 ,Ⅰ组为硝普钠组 ,Ⅱ组为丙泊酚复合硝普钠组。分别在控制性降压前 (T1) ,降压后 10min(T2 )、4 0min(T3 )及停降压后 10min(T4) ,记录降压期间血流动力学参数 ,采集颈内静脉血样测内皮素、血管紧张素Ⅱ和醛固酮浓度。记录硝普钠总用量和控制性降压时间 ,计算硝普钠输注速度 ;记录动脉血糖 (BGa) ,颈内静脉球部血糖 (BGjv) ,计算动脉 -颈内静脉球部血糖差(D(a jv) BG)和脑葡萄糖摄取率 (BGER)。结果Ⅰ组降压期间心率增快 (P <0 .0 5 ) ,Ⅱ组无心率增快 ,T4时刻MAP显著低于Ⅰ组 (P<0 .0 5 ) ;血管紧张素和内皮素在T3 、T4时刻Ⅰ组均显著高于Ⅱ组 (P <0 .0 5或P <0 .0 1)。Ⅰ、Ⅱ组动、静脉血糖与降压前相比逐渐升高 (P <0 .0 5 ) ;Ⅰ组D(a jv) BG和BGER降压后进一步下降 (P <0 .0 5 )。结论丙泊酚复合硝普钠控制性降压期间可减少硝普钠用量、降低快速耐药及反跳性高血压的发生 ,能有效抑制应激反应及与应激反应有关激素水平的增加 。
Objective To study the effects of controlled hypotension with propofol and sodium nitroprusside(SNP) on the stress response. Methods Thirty patients scheduled for ENT micro-surgery were randomly divided into groupⅠ(SNP)and groupⅡ(propofol and SNP).MAP,HR were recorded and venous blood samples were taken through right internal-jugular vein for the measurements of ET,AT-Ⅱand ALD before hypotension(T 1),during controlled hypotension at 10 min(T 2) and 40 min(T 3),10 min after ceasing hypotension (T 4).Arterial and venous blood glucose were also determined. Results Heart rate increased in groupⅠduring hypotension significantly (P< 0.05). MAP decreased in groupⅡat T 4(P<0.05). ET,AT-Ⅱincreased in groupⅠat T 4 significantly (P<0.01).In two groups blood glucose increased during hypotension(P<0.05). D (a-jv)BG and BGER decreased in groupⅠduring hypotension(P<0.05). Conclusion Propofol potentiates the hypotensive effect of SNP and reduces the dose requirement of SNP and incidence of complications. In addition propofol may attenuate stress response effectively.
出处
《上海第二医科大学学报》
CSCD
2004年第11期936-938,共3页
Acta Universitatis Medicinalis Secondae Shanghai
关键词
丙泊酚
硝普钠
控制性降压
应激反应
propofol
sodium nitroprusside
controlled hypotension
stress response
