血浆β-内啡肽和皮质醇对颅脑手术的应激评估被引量：4

导出

摘要目的观察神经外科手术中不同时间点的麻醉深度对血浆β-内啡肽、皮质醇和血糖的影响。方法10例经头部CT或MRI证实为颅内占位须行开颅手术的神经外科择期手术患者(ASAⅠ-Ⅱ级)。术前30min均给予力月西0.1mg/kg、阿托品0.01/kg肌注。麻醉诱导:力月西0.1mg/kg、芬太尼4μg/kg、异丙酚2mg/kg和维库溴铵0.15mg/kg诱导,气管插管后5min内不给任何麻醉药。呼吸机参数:呼吸频率12/min,潮气量10ml/kg,I∶E为1∶2。麻醉维持:术中持续输注异丙酚8-10mg/(kg.h)、维库溴铵1-2μg/(kg.min)、芬太尼28-34μg/(kg.h),持续吸入异氟醚0.8%-1.2%。结果自诱导睫毛反射消失至拔管时各时间点血浆中β-EP的浓度均明显低于诱导前(P<0.05或0.01)。各时间点血浆中Cor的浓度变化情况。诱导、插管时血浆Cor有所下降,和诱导前相比差异无统计学意义(P>0.05),插管后5min至拔管血浆中Cor下降明显(P<0.05或0.01)。自诱导开始,FBG有下降趋势,插管时下降明显(P<0.05),插管后5min进一步下降(P<0.01),之后回升,至拔管时忽然上升,并超过麻醉前水平,但差异无统计学意义。结论颅脑手术患者在实施全身麻醉以前就已经处于应激状态。全身麻醉后患者均有不同程度的应激反应抑制现象,既能抑制气管插管引起的应激反应,又能抑制手术导致的β-内啡肽、皮质醇和血糖升高。

作者王涛陆海斌孟尽海

机构地区银川市第三人民医院麻醉科宁夏医学院第二附属医院麻醉科宁夏医学院附属医院麻醉科

出处《军医进修学院学报》 CAS 2011年第2期158-160,共3页 Academic Journal of Pla Postgraduate Medical School

关键词 Β内啡肽氢化可的松血糖应激

分类号 R614.2 [医药卫生—麻醉学]

引文网络
相关文献

参考文献5

1金惠铭.病理生理学[M]5版[M].北京:人民卫生出版社,2002.163-189.
2徐华.手术应激反应研究进展[J].国外医学（麻醉学与复苏分册）,2003,24(5):278-281. 被引量：109
3Adams HA, Saatweber P, Schmitz CS, et al. Postoperative pain management in orthopaedic patients: no differences in pain score, but improved stress control by epidural anaesthesia [ J ] . Eur J Anaesthesiol, 2002, 19 ( 9 ) : 658-665.
4Akural EI, Salomaki TE, Tekay AH, et al. Pre-emptive effect of epidural sufentanil in abdominal hysterectomy [ J ] . Br J Anaesth, 2002, 88 (6) : 803-808.
5Hentgen E, Houfani M, Billard V, et al. Propofol-sufentanil anesthesia for thyroid surgery : optimal concentrations for hemodynamic and electroencephalogram stability, and recovery features [ J ] . Anesth Analg, 2002, 95 ( 3 ) : 597-605.

二级参考文献21

1Heller AR, Lity R J, Djonlagic I, et al. Combined anesthesia with epidural catheter. A retrospective analysis of the perioperative course in patients ungoing radical prostatectomy. Anaesthesist, 2000, 49: 949-959.
2Nielsen HJ, Nielsen H, Jensen S, et al. Ranitidine improves post operative monocyte and neutrophil function. Arch Surg, 1994,129:309-315.
3Schulze S, Sommer P, Bigler D, et al. Effect of confined prednisolore, epidural analgesia, and indomethacin on the systemic response after colonic surgery. Arch Surg, 1992,127:325-331.
4Chrousos GP, Gold PW. The concepts of stress and stress system disorders. Oxerview of physical and behavioral homeostasis. JAMA, 1992,267(9) : 1244-1252.
5Solomon GF. Psychoneuroimmunology: interactions between central nervous system and immune system.J Neurosci Res, 1987,18:1.
6Weissman C.The metabolic response to stress:an overview and update. Anesthesiology, 1990, 73:308-327.
7Lewis KS, Whipple JK, Michael KA, et al. Effects of analgesic treatment on the physiological consequences of acute pain. Am J Hasp Pharm, 1994,51 : 1539-1554.
8Lin S, Carpenter RL, Neal JM, et al. Epidural anesthesia and analgesia: their role in postoperative outcome. Anesthesiololgy, 1995, 82:1488-1490.
9Rosenfeld BA, Faraday N, Compbell D, et al. Homostatic effects of stress hormone infusion. Anesthesiology, 1994,81(5) : 1116-1126.
10Elenkov IJ, Wevster EL,Torpy DJ, et al. Stress, corticotropin releasing hormone, glucocort-icoids, and the immune/inflammatory response:acute and chronic effects. Ann N Y Acad Sci, 1999,876(1):11-13.