肿瘤相关性贫血对吸入和静脉麻醉效能的影响

目的 比较不同程度肿瘤相关性贫血对七氟烷吸入麻醉和丙泊酚全凭静脉麻醉效能的影响。方法 选择择期行腹腔镜手术的肿瘤相关性贫血患者120例，按照患者术前血红蛋白水平分为三组：正常血红蛋白组（A组：n=40，Hb≥120 g/L）、轻度贫血组（B组：n=40，90≤Hb<120　g/L）、中度贫血组（C组：n=40，60≤Hb<90　g/L），各组再随机分为七氟烷吸入麻醉（S组，n=20）和丙泊酚全凭静脉麻醉（P组，n=20）两个亚组。分别于诱导前（T1）、插管前（T2）、插管即刻（T3）、气腹建立时（T4）、拔除气管导管时（T5）和术后2 h（T6）抽取静脉血，记录各时点血氧饱和度（SpO₂）、平均动脉压（MAP）、心率（HR）和脑电双频指数（BIS）；记录气腹压、气腹时间、总出血量、输血量和总输液量；比较每组患者血管活性药物使用情况、所需丙泊酚或七氟烷用量、睁眼时间、拔管时间及术后躁动和恶心呕吐的发生率；用酶联免疫吸附试验检测血清皮质醇、5-羟色胺（5-HT）的浓度。结果 S组内比较七氟烷用量差异无统计学意义（P>0.05），而CP组患者诱导及维持期丙泊酚用量较AP组明显减少（P<0.05）。S组睁眼时间比P组短（P<0.05），术后躁动、恶心呕吐的发生率比P组高（P<0.05）。S组和P组患者T3、T5时点较T1时点的皮质醇与5?鄄HT浓度明显升高，较T2时点明显下降，差异有统计学意义（P<0.05），组间与组内比较差异均无统计学意义（P>0.05）。结论　肿瘤相关性贫血患者丙泊酚全凭静脉麻醉较七氟烷吸入麻醉术后苏醒慢，但躁动及呕吐发生率低。中度贫血患者较正常血红蛋白患者丙泊酚全凭静脉麻醉用药少，但血管活性药物使用率高。

Influence of malignant anemia on anesthetic efficacy of sevoflurane based-inhalational anesthesia and propofol intravenous anesthesia

Objective To compare the effects of different severities of malignant anemia on anesthetic efficacy of sevoflurane based-inhalational anesthesia and propofol intravenous anesthesia. Methods A total of 120 patients undergoing elective laparoscopic surgery during genneral anesthesia at our hospital were enrolled in this prospective study.Patients were divided into three groups based on preoperative hemoglobin level：normal hemoglobin （n=40，Hb≧120 g/L），mild anemia （n=40，90≤Hb<120 g/L），and moderate anemia （n=40，60≤Hb<90 g/L）. Patients were also divided into one group that received sevoflurane inhalation anesthesia（n=20） and one group that received intravenous anesthesia with propofol （n=20）. Pulse oxygen saturation （SpO₂），mean blood pressure （MBP），heart rate （HR） and bispectral index （BIS） were recorded before induction （T1），before intubation （T2），at intubation （T3），at pneumoperitoneum （T4），at extubation （T5） and 2 h after operation （T6）. Data were recorded on pneumoperitoneum pressure and duration，hemorrhage volume，transfusion volume of fluid and blood，vasoactive therapy，propofol or sevoflurane dosage，time to open eyes，time to intubation，incidence of postoperative agitation，and incidence of postoperative nausea and vomiting. Serum levels of cortisol and 5-serotonin （5-HT） were assessed using enzyme-linked immunosorbent assay. Results Dosage of sevoflurane was similar across the normal hemoglobin，mild anemia and moderate anemia subgroups among patients receiving sevoflurane.In contrast，propofol dosage differed significantly between the normal hemoglobin and moderate anemia subgroups. Patients receiving sevoflurane showed significantly shorter time to eye opening than those receiving propofol，but they also showed significantly higher incidence of postoperative nausea，vomiting and dysphoria.Cortisol and 5-HT concentrations were significantly higher at T3 and T5 than at T1，while levels were significantly lower at T2 than at T1. Conclusions Sevoflurane inhalation anesthesia was associated with faster revival but also higher incidence of postoperative nausea，vomiting and dysphoria than intravenous anesthesia.Moderate anemia was associated with lower propofol dosage and volatile hemodynamics.