瑞芬太尼清醒镇静对血糖、皮质醇、白细胞介素-6的影响

目的本研究拟评价瑞芬太尼清醒镇静术对血糖、皮质醇、白细胞介素-6的影响。方法择期ASAⅡ级拟在硬膜外麻醉下行腹部手术的患者40例。随机分为对照组20例（C组）、瑞芬太尼组20例（R组）。硬膜外给药30min后,R组：给予6μg/（kg·h）瑞芬太尼连续输注,对照组：给予0.3ml/（kg·h）生理盐水连续输注。输注过程中调整输注速度使患者OAA/S=3分。维持OAA/S评分需要调整药物剂量时,R组以1μg/（kg·h）增减。术毕停止输注药物,镇静过程中持续鼻导管吸氧。记录于T1（麻醉前）、T2（输注30min）、T3（药物停止输注后10min）时点取静脉血测定血糖、皮质醇、白细胞介素-6。用VAS评分法评定患者术中的焦虑分数。结果患者一般资料无差别。R组瑞芬太尼平均输注速度为（6.4±1.5）μg/（kg·h）。IL-6在二组中均有上升趋势,C组在T2、T3时点较T1有显著意义的升高（P〈0.05）。皮质醇在C组中的T2、T3时点较T1显著升高（P〈0.05）,血糖在T3时点C组、较T1显著升高（P〈0.05）。R组的焦虑分数（VAS）显著低于C组（P〈0.01）。结论在硬膜外麻醉下腹部大手术中,应用瑞芬太尼清醒镇静能有效的降低血糖、皮质醇、白细胞介素-6升高水平,患者焦虑分数低。

Effect of remifentanil on blood glucose,cortisol,IL-6 for conscious sedation in abdominal surgery

Objective To evaluate the effect of remifentanil on blood glucose, Cortisol, IL-6 for during conscious sedation abdominal surgery. Methods After informed consent was given,40 ASA Ⅱ patients undergoing abdominal surgery were randomly individed into two groups with 20 patients in each：control group（ group C）,Remifentanil group （group R）, The patients received continous intraveous infusion without loading dose, remifentanil 6 μg/（ kg ·h） （ Group R） or saline 0. 3 ml/（ kg·h） （ group C）. Depth of sedation was maintained at the Obsever＇ s Assessment of Altertness/Sedation Scale（OAA/S） = 3 by adjusting the rate of hypnotics. IL-6, cortisol,blood glucose were determined before anesthesia（baseline） （T1）, infusion 30 min（ T2 ） , stopping infusion 10 min（ T3 ）. The scores of anxiety was measured with a visual analog scale. Results There was no significant difference in age,body weight,duration of sedation. The infusion rate of remifentanil was 6.4 ± 1.5 μg/（ kg · h）in group R. IL-6 was increased in all groups,but there was significantly changed at T2 、T3 as compared with T1 in group C （P 〈 0. 05 ）. Cortisol was significantly increased at T2, T3 as compared with T1 in group C （ P 〈 0. 05 ）. Blood glucose was increased at T3 as compared with T1 in group C （ P 〈 0. 05 ）. The scores of patients anxiety was higher in group C than in group R（ P 〈 0.01 ）. Conclusion Remifentanil can significantly decrease the level of the blood glucose,cortisol, IL-6 in patients undergoing abdominal surgery.