异丙酚对全麻病人呼吸循环及应激反应的影响

目的探讨镇静和麻醉剂量异丙酚复合麻醉对全麻手术中呼吸循环及应激反应的影响。方法30例年龄40-60岁行上腹部或胸部手术的患者。入室后持续监测有创平均动脉压(MAP)、心率(HR)、心电图(ECG)、无创脉搏氧饱和度(SpO2),并听觉诱发电位指数(AAI)。30例患者随机分为三组,每组10例:对照组(C组)给0.9％生理盐水;异丙酚(P1)镇静剂量组,用微量泵持续注入异丙酚4mg.kg-1.h-1;异丙酚(P2)麻醉剂量组,持续注入异丙酚9mg.kg-1.h-1。三组分别于入室时(T)和切皮前(To)及切皮后0.5小时(T1)、腹腔或胸腔探查结束后(T2)时测定血液动力学(MAP、HR、CVP、)、肺顺应性(Cdyn)。并分别在T、T1、T2点取动脉血测血气(PO2、PaCO2和pH)和血糖(Glu),所有数据用统计软件SPSS 10.0进行处理。结果(1)血流动力学 C组MAP和HR在T2时较T、To显著增高,P1组无变化,P2组明显降低,与其它两组比较差异显著(P<0.05)。(2)麻醉深度三组间相同时点 AAI变化无显著差异。(3)动脉血气 三组PaO2在To后均保持在100mmHg以上。2组与C组比较差异显著(P<0.05),三组PaCO2略升高,三组pH均有一定的降低,但组间比较无差异。(4)肺顺应性C组的顺肺应性显著降低(P<0.05),到T1时仍在较低水平,而另2组则逐渐恢复,P2组在各时点均明显高于C组。(5)血糖C组血糖值在手术过

Effect of propofol on respiration circulation and stress response of patients undergoing upper abdominal and chest surgery

To study the effects of propofol on respiration circulation and stress response of patients undergoing upper abdominal and chest surgery. Methods 30 patients were divided into three groups randomly: control group (group C) received inteavenous normal saline; group P1 received iv propofol 4mg. kg-1, h-1; group P2 received iv propofol 4mg. kg-1, h-1. Hemodynamic changes MAP, HR, ECG, blood gas (PaO2, PaCO2, pH), blood glucose and lung dynamic compliance were measured before anesthesia (T), before skin incision (T0), changes 0. 5h after skin incision (T1) and exploration (T2). Results 1. Hemodynamics MAP and HR increased from T0 to T2 in group C while they were decreased in group P2 and remained unchanged in group P1. 2. Depth of anesthesia: There was no significant difference in AAI in the three groups. 3. Arterial blood gases PaO2 maintained higher than l00mmHg during operation in group P1 , P2 and C. PaO2 was higher in group C and lower in group P1 , P2. 4. Dynamic lung compliance decreased in all patients after induction but was gradually increasing during in group P2. 5. Blood Glucose: Glu was much higher in group C than that group P1 and P2 (P<0. 05). Conclusions High-dose propofol is much effective on suppressing surgical stress response in patientns undergoing upper abdominal and chest surgery than the lower-dose propofol, but it also inhibit cardioprotective stress hormone.