不同全麻诱导药对循环及内分泌功能的影响

目的 评价三种静脉药在全麻诱导时对循环、垂体－肾上腺皮、髓抽内分泌功能的影响。方法 将择期全麻手术病人43例，随机分为三组：Ⅰ（组（异丙酚2.5mg/kg）；Ⅱ组（硫喷妥钠5mg/kg）和Ⅲ组（依托咪酯03mg/kg）各14例。行桡动脉直接测压，同时边疆监测ECG、SpO2。快速静注琥珀碱1.5-2.0mg/kg行气管插管。插管2min后静注维库溴铵4mg,5min后各组吸入安氟醚维持1.3MAC,15min后复合吸入N2O。在诱导前（T0），窥喉插管即刻（T1），插管后2min（T2），5min(T3),15min(T4)取外周静脉血测定血浆去甲肾上腺素（NE）、肾上腺素（E）、皮质醇（cort）、泌乳素（PRL）、生长素（GH）、β－内啡肽（β－EP）、胰岛素和血糖的水平。结果 异丙酚诱导气管插管能抑制高血压反应，不增加心肌耗氧量，明显优于友喷妥钠和依插咪酯；三药诱导气管插管均不能抑制E和NE升高；均使腺垂体分泌PRL增加，而H、β-EP无变化；插管后15min依托咪酯使肾上腺皮质分泌cort减少；使血糖升高，胰岛素降低；说明对糖耐量呈现抑制作用。结论 异丙酚对循环和内分泌影响较小，是目前首选的全麻诱导药。

Effects of three intravenous anesthetics on circulatory and pituitary-adrenal functions during induction

Objective Induction of general anesthesia end endotracheal intubation may have profound effects on hemodynamic and endocrine functions and result in serious complications and even death. We compared the effects of propofol, thiopental and etomidate on the circulatory and pituitaryadrenal functions in order to evaluate the efficacy and safety of the agents. The study may provide useful information for clinical selection of induction agents. Methods Forty-three patients undergoing elective surgery were randomly divided into three groups. Before induction radial artery was cannulated for continuous monitoring of blood pressure and heart rate, ECG and SpO2 were also monitored continuously. Anesthesia was induced with intravenous propofol 2.5mg/kg (group Ⅰ), thiopental 5mg/kg (group Ⅱ), or etomidate 0.3mg/kg (group Ⅲ). Succinylcholine was then administered intravenously to facilitate intubations. 2 min after intubation vecuronium 4mg/kg was given Ⅳ; 5 min after intubation enflurane inhalation was started end maintained at 1.3MAC, at 15th min nitrous oxide was given. All patients were mechanically ventilated. End-tidal enflurane was monitored by Datex gas detector. Blood samples were taken from peripheral vein for the measurement of NE, E, PRL, GH, β-EP, insulin and blood glucose before induction (T0), during intubation (T1) and 2, 5, 15 min after intubation. Results The study showed that propofol attenuated the increase in BP and the oxygen consumption of myocardium during induction and intubation. None of the three drugs inhibited increase in E and NE during induction and intubation. They all increased PRL secretion from pituitary gland but produced no effects on blood on GH and β-EP. Etomidate inhibited the cortisol secretion and increased plasma glucose level and decreased insulin secreation at 15th min after intubation. Conclusions Propofol has less effects on circulatory and pituitary-adrenal functions, and is an intravenous anesthetic of choice for induction.