靶控输注麻醉对腹腔镜胆囊切除术患者应激反应的影响

目的比较丙泊酚、雷米芬太尼靶控输注和吸入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60例择期LC,按就诊顺序编号,按随机数字表随机分为2组,实验组（n=30）和对照组（n=30）,分别测定对照组（采用常规全麻诱导,吸入异氟烷和笑气复合麻醉）和实验组（诱导和维持采用丙泊酚、雷米芬太尼血浆靶控给药）患者诱导前（t1）和气腹后20min（t2）血清中皮质醇、IL-6的水平,并观察2组7个时间点（T0～T6）MAP、HR的变化。结果实验组t1时点皮质醇浓度（227.48±50.81）μg/L与对照组（233.21±41.02）μg/L无统计学差异（t=0.481,P=0.633）,但实验组t2时点（241.00±69.11）μg/L与对照组（354.70±37.55）μg/L有显著差异（t=7.918,P=0.000）。实验组t1时点IL-6浓度（105.99±30.65）ng/L与对照组（111.20±34.80）ng/L无统计学差异（t=-0.615,P=0.541）,但实验组t2时点IL-6浓度（116.06±30.89）ng/L与对照组（172.73±23.54）ng/L有显著差异（t=-7.992,P=0.000）。MAP及HR：实验组T0～T6MAP和HR均无显著变化（F=0.92,P=0.485;F=0.41,P=0.878）,但对照组MAP和HRT0～T6有显著差异（F=10.11,P=0.000;F=10.44,P=0.000）。实验组T2～T5时点MAP、HR明显低于对照组,差异有显著性（P〈0.05）。结论全凭静脉靶控输注丙泊酚和雷米芬太尼麻醉较常规吸入复合全麻能有效地抑制LC引起的应激反应,维持血流动力学的相对稳定。

Effect of Target-controlled Infusion Anesthesia on the Stress Response in Patients Receiving Laparoscopic Cholecystectomy

Objective To compare the effects of target-controlled infusion （TCI） of propofol and remifentanil and inhalation anesthesia on the stress response in patients undergoing laparoscopic cholecystectomy （LC）. Methods Selective LC was performed on 60 cases. Before the surgery,the patients were randomly divided into experiment （TCI of propofol and remifentanil） and control （standard general anesthesia combined with inhalation of fluorinated alkane and laughing gas） groups with 30 cases in each. The serum levels of cortisol and IL-6 were detected before the induction （t1） and 20 minutes after pneumoperitoneum （t2）. In addition,the MAP and HR of the two groups were monitored at seven time points. Results The serum levels of cortisol and IL-6 in the experiment group were similar to those in the control at t1 Cortisol：（227.48±50.81） μg/L vs （233.21±41.02） μg/L,t=0.481,P=0.633, IL-6：（105.99±30.65） ng/L vs （111.20±34.80） ng/L,t=-0.615,P=0.541],but significantly lower at t2 Cortisol：（241.00±69.11） μg/L vs （354.70±37.55） μg/L,t=7.918,P=0.000, IL-6：（116.06±30.89） ng/L vs （172.73±23.54） ng/L,t=-7.992,P=0.000]. The MAP and HR in the experiment group were significantly lower than those in the control at t2 to t5 （5,10,15,and 20 minutes after the pneumoperitoneum, P〈0.05）. Conclusions TCI of propofol and remifentanil can effectively induce stress response during LC,while maintaining a relatively stable hemodynamics. The effects are better than inhalation general anesthesia.