异丙酚与依托咪酯复合硬膜外阻滞对血糖和皮质醇的影响

目的和方法：１２０例ＡＳＡⅠ～Ⅱ级成年病人，按照全麻诱导和维持用药随机分成依托咪酯（Ｅ组，ｎ＝６０）和异丙酚（Ｐ组，ｎ＝６０）两组。两组病人均硬膜外穿刺置管，Ｅ组病人诱导用依托咪酯０２５ｍｇ／ｋｇ，维持时负荷剂量为２０μｇ·ｋｇ－１·ｍｉｎ－１，维持剂量为６μｇ·ｋｇ－１·ｍｉｎ－１；Ｐ组病人诱导用异丙酚１５ｍｇ／ｋｇ，维持时负荷剂量为１６０μｇ·ｋｇ－１·ｍｉｎ－１，维持剂量为５０μｇ·ｋｇ－１·ｍｉｎ－１。观察术中心血管反应、血浆皮质醇和血糖的变化。结果：异丙酚和依托咪酯静脉诱导后均可造成血压下降，异丙酚较为严重，但术中两组病人的血压脉率皆容易维持稳定。两组病人术中血糖随着手术进程缓慢升高，Ｐ组病人血浆皮质醇变化与血糖相似，而Ｅ组病人术中血浆皮质醇水平缓慢降低，直至术后２４小时方恢复。结论：在硬膜外阻滞复合异丙酚静脉全麻时，尽管手术创伤所致的心血管应激反应已经控制，但体内应激激素依然保持适度增高。而依托咪酯则抑制肾上腺皮质，致血浆皮质醇水平下降，不适合用作长期静脉麻醉的维持。

The Effect of Epidural Block Conbined with Total Intravenous Anesthesia with Etomidate or Propofol on the Plasma Cortisol and Glucose Levels

Objective and Methods: 120 ASA adult patients were randomly allocated into etomidate group(group E, n=60) and propofol group (group P, n=60) according to the intravenous anesthetics used to induce and maintain the anesthesia. In group E, etomidate was given in an induction dose of 025mg/kg over 45 seconds, followed by 20gkg-1min-1 for 15 minutes and 6gkg-1min-1 thenafter. In group P, anesthesia was induced with propofol 15mg/kg over 45 seconds, followed by 160gkg-1min-1 for 15 minutes and 50gkg-1min-1 thenafter. All patients received epidural block during the operations. Changes of plasma cortisol, glucose concentration and the cardiovascular responses were investigated perioperatively. Results: The blood pressure was lowered after intravenous induction with either etomidate or propofol, particularly with propofol. The concentration of plasma glucose was elevated in both groups. The concentration of plasma cortisol was increased slightly in group P, but was gradually lowered during operation and restored to the control value in 24 hours after operation in group E. Conclusion: Although the circulatory response to surgical invasion can be controlled by propofol, the plasma cortisol with stress response is increased slightly. Etomidate inhibits the function of the adrenal cortex, leading to a decrease in cortisol secretion. Etomidate is not suitable for the maintain of total intravenous anesthesia during prolonged operations.