丙泊酚麻醉与异氟醚麻醉对血液流变学影响的对比观察

目的对比观察食道癌根治术中持续泵注丙泊酚麻醉与吸入异氟醚麻醉对血液流变学的影响。方法择期行食道癌根治术（开胸）患者30例,分为A、B两组（n=15）,术中A组持续泵注丙泊酚4mg/（kg.h）、B组吸入异氟醚（吸入浓度1%-2%）;所有患者均采用瑞芬太尼0.2μg/（kg.min）和维库溴铵0.03mg/kg维持镇痛和肌松。于麻醉前（T1）,切皮后60min（T2）、120min（T3）、180min（T4）时抽取颈内静脉（中心静脉）血,监测上述各时间点的全血黏度（高切、中切、低切）、血浆黏度、红细胞压积、红细胞聚集指数、红细胞刚性指数、纤维蛋白原。结果与基础值比较,A组患者血液流变学各指标均显著降低（P〈0.05）;B组全血黏度、红细胞刚性指数显著降低（P〈0.05）,B组T3、T4时全血中、低切黏度也较T1时显著降低（P〈0.05）,血浆黏度和纤维蛋白原麻醉后略有增高,但各时间点差异无统计学意义（P〉0.05）。结论术中持续输注4mg/（kg·h）丙泊酚比吸入异氟醚更能有效降低食道癌患者的血液黏度。

Comparison of the changes in hemorheology during isoflurane anesthesia and propofol anesthesia

Objective To investigate the changes in hemorheology during anesthesia with isoflurane and propofol in patients with esophageal cancer.Methods Thirty patients（ASA physical status I or II,51-72 yr） scheduled for thoracotomy and the patients were randomly divided to two groups（n=15）： the patients in group A were given propofol（4 mg·kg^-1·h^-1） by continued intravenous infusion and the patients in group B were inhaled with isoflurane（1-2%）.Jugular vein catheter was implanted after anesthesia induction.The blood samples in all patients were taken from jugular vein catheter after anesthesia induction（T1） and at 60min（T2）,120min（T3）,and 180min（T4） after incision for haemorheological assay.Detection parameter including blood rheology： whole blood viscosity（WBV）,plasma viscosity,blood revert viscosity（BRV）,hematocrit（HCT）,RBC aggregation index,RBC rigidity index and fibrinogen were also tested at T1,T2,T3 and T4 time points.Results Blood rheology： compared to basic value,WBV,BRV,HCT,RBC aggregation index,RBC rigidity index declined in group A at T2,T3,T4 vs.T1（P〈0.05）.In group B,WBV,RBC rigidity index declined at T2,T3,T4vs T1（P〈0.05）.BRV,fibrinogen raised in all time point,there is no statistical significance（P〉0.05）.Conclusion Propofol 4mg/kg/h can decrease the blood viscosity in patients with esophageal cancer.