参麦预处理对全身麻醉下全髋关节置换术患者应激反应的影响

目的:观察参麦注射液预处理能否减轻全身麻醉下全髋关节置换术患者的应激水平。方法:40例手术患者随机平均分为对照组和参麦组。参麦组术前2 d以30 ml加入5%葡萄糖溶液250 ml静脉滴注,术前当天在麻醉前30 min滴完。麻醉诱导:咪达唑仑2μg/kg,芬太尼2~4μg/kg,丙泊酚2 mg/kg,维库溴胺0.08~0.1 mg/kg,气管插管后接麻醉机行机械纯氧通气并吸入七氟醚,术中丙泊酚2~4 mg/(kg.h)持续泵注,切皮前静脉滴注芬太尼0.05 mg,术中间断追加,并在手术结束前10min静脉滴注曲马多100 mg。麻醉期间监测时间分为麻醉诱导前(T0),气管插管后5 min(T1),手术开始切皮(T2),拔管后5 min(T3)。各时间点记录平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2),测定血糖浓度(BS)、皮质醇浓度(Cor)。结果:麻醉诱导前两组患者HR、MAP、SpO2差异无统计学意义(P>0.05),与T0比较,两组MAP在T1下降,T3时间点升高,对照组T1时点MAP下降较参麦组明显(P<0.05),T3时点较参麦组升高明显(P<0.05)。两组HR在T3时点与T0比较均升高,对照组较参麦组明显升高(P<0.05)。两组SpO2差异无统计学意义(P>0.05)。对照组血糖在T1、T2、T3均升高明显(P<0.05),参麦组无明显变化,两组在T1、T2、T3时点差异有统计学意义(P<0.05)。与参麦组比较,对照组Cor在T1、T2、T3均升高;与T0比较,对照组Cor在T1、T3升高(P<0.05),T2下降,参麦组T2下降,T3升高。结论:参麦预处理较有效的抑制了全身麻醉下全髋关节置换术患者的应激反应。

Effects of Shenmai injection pretreatment on stress reaction in patients during total hip replacement surgery under general anesthesia

Objective To investigate the effects of Shenmai injection pretreatment on the stress reaction in patients during total hip replacement surgery under general anesthesia.Method Total 40 cases of surgical patients were randomly divided into two groups with 20 cases each other：the control group A and Shenmai group B.Group B received 5% glucose injection 250 ml added with Shenmai injection 30 ml once a day for 2 days and in 30 min before anethesia.The two groups had the same anesthesia induction as follows：midazolam 2 μg/kg,fentanyl 2-4 μg/kg,propofol 2 mg/kg,vecuroniu bromide 0.08-0.1 mg/kg,and then followed by machanical ventilation with oxygen and sevoflurane inhalation after trachea cannula,infused with propofol 2-4 mg/kg continuously.Fentanyl was given 0.05 mg before skin incision and the same dose whenever necessary during the surgery.Tramadol was given 100 mg 10 min before the end of the surgery.MAP,HR,SpO2,BS and Cor were monitored at：before anesthesia induction（T0）,5 min after trachea cannula（T1）,skin incision（T2）,5 min after taking away the tube（T3）.Results There were no significant changes in HR,MAP and SpO2（P〈0.05） before anesthesia induction.Compared to T0,MAP in the two groups was decreased at T1 and increased at T3.MAP in group A was decreased more than those in group B at T1（P〈0.05） and had the oposite effect at T3.HR in group A and B were increased at T3 compared with T1 and group A was increased more than those in group B（P〈0.05）.There was no significant changes of SpO2 in two groups（P〈0.05）.BS in group A was increased at T1,T2,T3 and there was no changes in group B,and there were significant changes between the two groups at T1,T2,T3（P〈0.05）.Cor in group A was increased more significantly than those in group B at T1,T2,T3（P〈0.05）.Compared to T0,Cor in group A was increased at T1,T3（P〈0.05） and was decreased at T2.Cor in group B was decreased at T2 and was increased at T3.Conclusion Shenmai injection pretreatment can inhibit the stress reaction more effectively in patients during total hip replacement surgery under general anesthesia.