腹腔镜胆囊切除术中不同麻醉方法对应激反应的影响

目的：观察以丙泊酚、瑞芬太尼为主的全凭静脉麻醉对腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）患者应激反应的影响。方法：将ASA I-II级需行LC的患者随机分成两组（A组丙泊酚、瑞芬太尼诱导并维持,B组丙泊酚、芬太尼诱导异氟醚吸入维持）,每组30例。记录两组麻醉前（T0）、插管后即刻（T1）、气腹后即刻（T2）、气腹后30min（T3）及术毕（T4）的平均动脉压（MAP）、心率（HR）,于T0、T2、T3及术后2h抽取静脉血检测患者血糖、血浆皮质醇、肾上腺素及去甲肾上腺素浓度。结果：T1和T2A组MAP、HR显著低于B组（P〈0.01）。两组血浆皮质醇、肾上腺素及去甲肾上腺素浓度,T2和T3浓度均明显升高（P〈0.01,P〈0.05）,A组患者上升幅度明显低于B组（P〈0.01,P〈0.05）。血糖于T3至T4两组患者均明显升高（P〈0.01,P〈0.05）,,两组间无明显差别。结论：以丙泊酚和瑞芬太尼为主的全凭静脉麻醉,较以异氟醚和芬太尼为主的传统麻醉用于LC,能够更有效的抑制气管插管和二氧化碳气腹所致的应激反应。

Effect of different methods of anaesthesia on the stress during laparoscopic cholecystectomy

Objective:To evaluate the effect of general intravenous anesthesia with propofol and remifentanil on the stress response caused by laparoscopic surgery.Methods:A prospective,randomized,controlled study was performed.60 patients(ASA I,II)scheduled for laparoscopic surgery were randomly allocated into two groups,either receiving total intravenous anesthesia with propofol and remifentanil(groupA)or balanced anesthesia with fentanyl and isoflurane(group B).Mean arterial pressure(MAP),heart rate(HR),peripheral sugar(Glu),plasma concentration of cortisol,epinephrine and norepinephrine at different time during anesthesia were recorded.Results:MAP and HR of group A were lower than those of group B at the time just after tracheal intubations and pneumoperitoneum(P<0.01).The plasma concentration of Corticoid,epinephrine,nor epinophrine were increased in both groups at the time just after pneumoperitoneum and 30min later(P<0.05),but group B were higher than that of group A(P<0.01,P<0.05);Blood glucose were higher in both groups at the time 30min after pneumoperitoneum and the end of the operation(P<0.01,P<0.05).There were no significant difference between two groups.Conclusions:Compared with the balanced anesthesia with fentanyl and isoflurane,general intravenous anesthesia with propofol and remfentanil can restrain the stress response caused by tracheal intubation and pneumoperitoneum more effectively during laparoscopic surgery.