摘要
目的 观察依托咪酯对腹腔镜胆囊切除术患者细胞因子和肾上腺皮质功能的影响.方法 将40例择期行腹腔镜胆囊切除术患者(ASAⅠ～Ⅱ级)随机分为依托咪酯组(E组)和异丙酚组(P组),每组20例.麻醉诱导给予芬太尼0.005 mg/kg,维库溴胺0.1 mg/kg,E组用依托咪酯0.3 mg/kg, P组用异丙酚2 mg/kg.术中麻醉维持:E组给予依托咪酯20～25 μg/(kg·min), P组给予异丙酚6～10 mg/(kg·h).分别在麻醉前(T1)、气腹即刻(T2)、术后即刻(T3)、术后12 h(T4)、术后24 h(T5)、术后48 h(T6)抽静脉血,测定血皮质醇、白细胞介素(IL)-6及IL-10水平.结果 T2～T5时刻P组皮质醇浓度高于E组(P<0.05),两组皮质醇浓度于T6时点均恢复至术前水平.IL-6:两组术中T2时点开始升高,至术后T4(与T1相比,P>0.05)时点达到高峰,术后48 h恢复至正常水平;P组IL-6在T3、T4时点高于E组(P<0.05).IL-10组间比较差异无统计学意义.结论 在腹腔镜胆囊切除术中,应用依托咪酯静脉持续输注安全有效.
Objective To observe the infuence of etomidate on adrenocortical function and cellular factor in patients undergoing laparoscopic cholecystectomy. Methods Forty patients scheduled for elective laparoscopic cholecystectomy (ASAⅠ- Ⅱ) were randomized into the etomidate group (group E) and the propofol group (group P) with 20 cases in each group. Patients were induced with fentanyl 0.005 mg/kg, vecuronium 0.1 mg/kg, and etomidate 0.3 mg/kg (group E) or propofol 2 mg/kg(group P). Anesthesia as maintained with etomidate 20-25 μg/(kg·min) in group E or propofol 6-10 mg/(kg·h) in group P. Blood sample were taken before induction (T1), immediately after pneumoperitonieum (T2),immediately after operation(T3),12 h(T4) 24 h(T5) and 48 h(T6) after operation to measure plasma concentration of cortisol, IL-6 and IL-10. Results The concentration of cortisol were significantly higher in group P than group E at T2-T5, and restored to preoperative level in both groups at T6. The concentration of IL-6 increased from T2, peaked at T4 and restored to baseline at T6 in both groups. Significant differences were detected only at T3 and T4 between groups with a higher level in group P. No significant difference were detected in the concentration of IL-10 between groups at any time point. Conclusions continuous infusion of etomidate is effective and safe for laparoscopic cholecystectomy.
出处
《中国实用医刊》
2010年第14期29-30,共3页
Chinese Journal of Practical Medicine
