丙泊酚对体外循环期间去甲肾上腺素、内皮素、心钠素的影响

目的观察不同剂量丙泊酚对体外循环期间的应激反应的抑制作用。方法选择20例风湿性心脏瓣膜病患者,分为两组,体外循环期间以全凭丙泊酚〉6mg/（kg·h）控制血压组（P）和丙泊酚加尼卡地平控制血压组（N）各10例,两组体外循环前后麻醉方法相同。监测指标：分别于入室建立有创动脉压监测后（T1）、体外循环前（T2）、体外循环30min（T3）、停体外循环10min（T4）时采集动脉血4ml,检测各时点去甲肾上腺素（NE）、内皮素（ET）、心钠素（ANP）作为应激指标。结果组间比较：两组间各时间点的NE、ET、ANP血浆浓度比较差异无统计学意义;组内比较：P组NE、ET水平在T3、T4时显著升高,与T1相比差异有统计学意义,而ANP浓度各时间点相比均无显著差异;N组的变化趋势与P组基本一致。结论丙泊酚可以不同程度地抑制体外循环期间的应激反应。

The Effects of Propofol on Stress Hormone during Cardiopulmonary Bypass

Objective To observe the inhibitory effects of stress reaction during cardiopulmonary bypass by using different doses of propofol.Methods 20 patients with rheumatic heart valvular disease were randomly assigned to group P（n=10）,the mean blood pressure was controlled to 70-80mmHg by adjusting propofol infusion rate（6-10 mg/kg/h） and group N（n=10）,the mean blood pressure was controlled to 70-80mmHg by propofol infusion rate of 4mg/kg/h and adjusting nicardipine infusion rate.Blood sample（4ml） was taken before induction（T1）,before cardiopulmonary bypass（T2）,30 min after cardiopulmonary bypass（T3） and 10 min after cardiopulmonary bypass stopping（T4） for determining norepinephrine（NE）,endothelin（ET）,and atrial natriuretic polypeptide（ANP）.Results There were significant difference in NE,ET and plasma concentration of NE and ET at T3 and T4 plasma concentration were similar as those in group P.Conclusion There is inhibitory effects of stress reaction by using propofol infusion during cardiac valve replacement under cardiopulmonary bypass.