持续靶控输注丙泊酚与吸入异氟醚维持麻醉的比较

目的：比较持续靶控输液丙泊酚与吸入异氟醚维持麻醉下的应激反以及对血液动力学变化的影响。方法：择期行妇科手术病人20例，ASA I－Ⅱ级，随机分为靶控（T）组，吸入（I）组，每组各10例，丙泊酚靶控行麻醉诱导，气管插管后T组靶控维持，I组异氟醚吸入维持，术中控制麻醉深度于双频指数在（BIS）40－60之间，记录术前至术毕不同时点的皮质醇（Cor),血糖（Glu)，胰岛素（Ins)，血压，心率和BIS值，结果：与基础对比，诱导后两组皮质醇值都显著下降（P＜0．05），切皮后30分钟至关腹两组值均上升，且T组幅度略大，组间差异显著（P＜0．05），血糖值在切皮后均显著上升，I组术中高于T组，术毕低于T组（P＜0．05），T组胰岛素值轻度上升，与基础值比较无差异；I组在插管后10分钟时一过性抑制，与自身和T组比较差异显著（P＜0．05），诱导后两组收缩压，舒张压，心率均较基础值显著下降（P＜0．05），I组在插管后5－10分钟内收缩压，舒张压，心率抑制明显（P＜0．05），大多数病人需注射阿托品，两组BIS值在插管后5分钟和关腹时I组显著低于T组（P＜0．05），结论：靶 控输注能较好地抑制应激反应，维持心血管功能的稳定。

A comparison of anesthesia maintained by propofol target controlled infusion with isoflurane inhalation

Objective To compare the effects of propofol target controlled infusion with isoflurane inhalation on hemodynamics and hormone response to stress.Methods Twenty patients scheduled for gynecological surgery were divided into two groups with 10 cases each.The anesthesia was induced by TCI with propofol.Anesthesia was maintained with either isoflurane inhalation(Group I) or propofol by TCI(Group T).The depth of anesthesia was controlled by BIS in the range from 40 to 60.Cortisol,insulin and blood glucose levels were determined at the seven times points:30min after entering the operation room in the morning (baseline),5min after induction,5min after intubation,10min after intubation,5min after skin incision,30min after incision,just before peritoneal closing,and the end of operation.Results Cortisol levels decreased significantly from the baseline after induction in both groups.The increase in Cortisol was significantly greater in group T than that in group I at 30min after incision ( P< 0 05).Glucose level was all increased after incision,which was higher in group I than that in group T during surgery,but lower in group I than that in group T after surgery.At ten minutes after intubation,the insulin levels in group I were significantly lower than those in group T or the baseline.Five to ten min after intubation,SBP,DBP,HR were significantly lower in group I than those in group T ( P< 0 05).Most of the patents needed atropine treatment.By the end of the operation,BIS levels in group T were significantly higher than those in Group T.Conclusion Stress respones can be suppressed and steable cardiovascular function maintained by TCI of propofol.