贫血患者在无痛诊断性刮宫术中的应激反应与贫血程度的关系

【目的】研究无痛诊断性刮宫术中患者贫血程度与术中血压及应激指标的相互关系。【方法】本院拟行无痛诊断性刮宫术患者60例，根据贫血程度分为轻，中，重度三组，均采用靶控输注丙泊酚联合小剂量芬太尼的静脉麻醉方案，观察记录麻醉前（T0），手术前（T1）、手术中（T2）及术后10rain（T3）四个时点的心率（HR），收缩压（SBP），舒张压（DBP），脉搏血氧饱和度（SpO2），并分别抽取各时点静脉血，检测血浆去甲肾上腺素（NE）及肾上腺素（E）水平。【结果】重度贫血组各时点SBP和DBP与轻，中度贫血组比较显著降低（P〈0．05），NE值于T1-3点均显著低于轻，中度贫血组（P〈0．05），E值在T1和T2时间点显著低于轻，中度贫血组（P〈0．05）。【结论】无痛诊断性刮宫术中重度贫血患者血中持续较低的儿茶酚胺水平可能是导致术中血流动力学较大波动的原因。

Study on the Stress Response in Severe Anemic Patients During Painless Diagnostic Curettage

Objective] To investigate the relationship between the degree of anemia and intraoperative blood pressure and stress parameters of patients during painless diagnostic curettage. Methods]According to the degree of anemia, 60 patients scheduled for diagnostic curettage were divided into mild group（Group Ⅰ ）, moderate group（Group Ⅱ ） and severe group（Group Ⅲ ）. All the 3 groups received intravenous anesthesia with propofol and low dose of fentanyl by target-controlled infusion. Systolic blood pressure（SBP）, diastolic blood pressure（DBP）, heart rate（HR） and pulse oxygen saturation（SpO2） were recorded and plasma norepinephrine （NE） and epinephrine（E） levels were examined before anesthesia（T0）, before operation（T1 ）, during operation（T2） and 10min after operation（T3）. Results]Compared with group I and group Ⅱ , SBP and DBP in group Ⅲ decreased markedly at all time（ P 〈0.05）. NE in group Ⅲ at T1-3 was significantly lower than that in group I and group Ⅱ （ P d0.05）, and E in group Ⅲ at T1 and T2 was significantly lower than that in group I and group Ⅱ （ P 〈0.05） . Conclusion] Low level of plasma eatecholamine in moderate and severe anemia patients during painless diagnostic curettage may be the cause of the obvious fluctuation of intraoperative hemodynamics.