不同剂量异丙酚对老年人术中内皮素、一氧化氮的影响

目的 研究异丙酚复合麻醉对老年人术中内皮素、一氧化氮的影响,并探讨其不同剂量的效应。方法 选择无心肺、内分泌疾患、行上腹部择期手术的老年患者(年龄>60岁)18例,随机分为三组,每组6例。A组(对照组):不使用异丙酚;B组(小剂量组):异丙酚4mg·kg-1·h-1持续输入;C组(大剂量组):异丙酚8mg·kg-1·h-1持续输入。于入室时(T0)、切皮前(T0)、切皮后(T1)、胆腔探查结束后(T2)记录MAP、HR、AAI。同时经足背动脉抽取动脉血测定内皮素(ET)、一氧化氮(NO)。结果(1)血流动力学:A组T2MAP、HR较基础值显著上升。B组术中MAP、HR较平稳。A组T2MAP、HR较基础值显著上升。两个异丙酚组术中HR均有所下降,其中C组HR较术前明显降低。(2)ET、NO:术中ET、NO应激介质的抑制C组强于B组,B组强于A组。结论 大剂量异丙酚能更好抑制ET释放,并增加血浆NO浓度,但却有可能过度抑制老年人术中的保护性心血管应激;小剂量异丙酚能较好的调控术中的心血管反应在适度水平。

Effect of propofol on ET and NO of the elderly patients undergoing upper abdominal surgery

Objective To explore the iniluence of propofol combined anesthesia on ET and NO of the elderly patients undergoing abdominal surgery and compare the effectiveness and safety of its divided dose administration. Methods Eighteen elderly patients aged over 60 years were randomized divided into three groups that Group A without propofol served in control, Group B maintained with intravenous infusion of propofol at 4mg. kg-1. h-1, Group with propofol at 8mg. kg-1. h-1. Results 1. Hemo-dynamics parameters: MAP in group A was significantly increased at T2 than T0 (P<0. 05). MAP in group A was lower markedly than that in group B and C (P<0. 05). HR at T2 was slower markedly than at To in group C. HR in group C was lower than that in group A at T1, and HR in group A was higher than that in group B, C at T2. 2. ET and NO: ET in group A, B at T1 ,T2 showed higher markedly than at T0. ET in group A showed higher significantly than that in group B and C at T1 ,T2 (P<0. 05). NO/ET: Rate of group A decreased gradually at T0-T2 (P<0. 05), while group C was opposite to group A. Conclusion High-dose propofol is more effective on suppressing surgical stress of the elderly patients undergoing upper abdominal surgery, but it overinhibits cardioprotective stress hormone. Lower-dose propofol can regulate intraoperative cardiovascular stress on proper level.