丙泊酚靶控输注对鼻内镜手术病人应激反应的影响

目的观察丙泊酚靶控输注对鼻内窥镜手术病人应激反应的影响。方法40例ASA分级为Ⅰ-Ⅱ级行鼻内镜手术的病人,按随机数字表法分为A组（丙泊酚静脉注射2.5mg.kg^-1）和B组（丙泊酚靶控输注靶浓度4μg.ml^-1）,手术全部在全凭静脉麻醉下完成。手术前,手术后30min和气管拔管后60min,抽取外周静脉血检测皮质醇和血糖,并记录心率（heart rate,HR）和平均动脉压（mean artery pressure,MAP）。结果A组病人手术开始后30min心率（73±8）次/min明显高于B组病人（65±13）次/min（t=2.344,P=0.024）,MAP（74±7）mm Hg明显高于B组病人（68±7）mm Hg（t=2.711,P=0.010）,血糖（6.28±0.11）mmol/ml明显高于B组病人（5.31±0.15）mmol/ml（t=23.321,P=0.000）,皮质醇（125.3±11.5）ng/ml明显高于B组病人（89.6±9.9）ng/ml（t=10.521,P=0.000）。气管拔管后60min A组病人MAP（79±6）mm Hg显著高于B组病人（73±8）mm Hg（t=2.683,P=0.011）,血糖（6.18±0.09）mmol/ml明显高于B组病人（5.62±0.16）mmol/ml（t=10.082,P=0.000）,皮质醇（169.1±16.3）ng/ml明显高于B组病人（149.5±15.3）ng/ml（t=3.921,P=0.000）。结论丙泊酚靶控输注能较为有效地抑制鼻内镜手术刺激引起的应激反应。

Effect of Propofol Target-controlled Infusion on Stress Response during Nasoscopic Operation

Objective To observe the effect of propofol target-controlled infusion on stress response during nasoscopic procedures.Methods Totally 40 patients with ASA gradesⅠ-Ⅱ scheduled for the nasoscopic operation ware randomly divided into two groups：Group A（propofol continuously injection,2.5 mg·kg^-1,n=20）and Group B（propofol target-controlled infusion,4 μg·ml^-1,n=20）.The operations were all performed under general anesthesia.Venous blood samples were taken to measure cortisol and blood glucose at three time points：before operation,at 30 min after the operation started,and 60 min after the endotracheal catheter was withdrawn.Meanwhile,HR and MAP of the patients were recorded.Results At both 30 min after the operation started and and 60 min after the endotracheal catheter was withdrawn,Group A showed significantly higher MAP and serum levels of glucose and cortisol than Group B.At 30 min after the operation started：HR：（73±8）/min vs（65±13）/min,t=2.344,P=0.024;MAP：（74±7）mm Hg vs（68±7）mm Hg,t=2.711,P=0.010;blood glucose：（6.28±0.11）mmol/ml vs（5.31±0.15）mmol/ml,t=23.321,P=0.000;cortisol：（125.3±11.5）ng/ml vs（89.6±9.9）ng/ml,t=10.521,P=0.000.At 60 min after the endotracheal catheter was withdrawn：MAP：（79±6）mm Hg vs（73±8）mm Hg,t=2.683,P=0.011;blood glucose：（6.18±0.09）mmol/ml vs（5.62±0.16）mmol/ml,t=10.082,P=0.000;cortisol：（169.1±16.3）ng/ml vs（149.5±15.3）ng/ml,t=3.921,P=0.000.Conclusion Propofol target-controlled infusion can inhibit the stress response caused by nasoscopic operation.