体外循环中全程应用七氟烷对机体应激反应影响的随机对照研究

目的观察体外循环中全程使用七氟烷对机体的应激反应的影响。方法采用双肓，随机对照研究方法，100例18岁以上于2010年1月-2011年11月于我院体外循环下行心脏手术患者，分成七氟烷全程使用组（A组）（n=50）和全程静脉麻醉组（B组）（n=50）。全部患者监测桡动脉压，应用高效液相色谱法测定CPB开始时（T1）、鼻咽温降温至32℃（T2）、停止降温后15min（T3）、鼻咽温复温至32℃（T4）、CPB结束后15min（T5）血浆去甲肾上腺素（NE）和肾上腺素浓度（E）。结果两组患者MAP组间及组内在各个时间点均无显著性差异（P〉0．05）。组间比较，两组患者血浆NE、E的浓度在各时点均无显著性差异（P〉0．05）。组内比较，两组患者血浆NE、E的浓度在CPB开始时（T1）和鼻咽温降温至32℃（T2）时无照著性差异（P〉0．05）；在停止降温后15min（T3）、鼻咽温复温至32℃（T4）和CPB结束后15rain（T5）时显著高于CPB开始时（T1）和鼻咽温降温至32℃（T2）（p〈0．01）；鼻咽温复温至32℃（T4）显著高于停止降温后15min（T3）和CPB结束后15min（T5）（p〈0．01）；CPB结束后15min（T5）显著高于停止降温后15min（T3）（p〈0．01）。结论体外循环全程应用七氟烷具有类似静脉麻醉药的抑制体外循环引起应激反应的作用。

The Randomized Controlled Trial Study of the stress Reaction of Sevollurane Used Whole Process in CPB

Objective To observe the stress reaction of Sevoflumne used whole process in CPB. Methods Double blinded randomized controlled trial was used in this study. 100 patients who would have a cardiac operation were divided into two groups randomly： Sevoflumne used whole process in CPB（Group A, n=50）, anesthetic used just in vein （Group B, n=50）. All of these patients were more than 18 years old. Radial artery pressure were measured continuously during the perioperative period. In the following time points： at the beginning of CPB （TI）, cooling to 32% （T2）, 15min after stopping cooling（T3）, rewarming to 32% （T4）, 15min after CPB cooling （T5）,tbe plasma concentration of epinephrine （E） and norepinephrine （NE） were measured by using high performance liquid chromatography （HPLC）. Results MAP was no significant difference between the 2 groups（P〉0.05）. The plasma concentration of E and NE in T3 ,T4 ,T5 was significant higher than TI, T2 （P〈0.01） in group A and B. The plasma concentration of E and NE in T4 was significant higher than T3, T5 （P〈0.01） in group A and B. The plasma concentration orE and NE in T5 was significant higher than T3 （P〈0.01） in group A and B. Conclusion Sevoflurane used whole process in CPB which inhibit stress reaction have almost the same influence as intravenous anesthetics.