靶控输注舒芬太尼复合丙泊酚麻醉对高血压全麻患者应激反应的影响

目的观察靶控输注(TCI)舒芬太尼与丙泊酚对高血压全麻患者围麻醉期血流动力学及应激反应的影响。方法选择择期全麻腹部手术的高血压患者40例,随机分为舒芬太尼组(SF组)和芬太尼组(F组)。SF组麻醉诱导舒芬太尼靶浓度为0.5μg.L-1,麻醉维持舒芬太尼靶浓度不变;F组麻醉诱导芬太尼4μg.kg-1,麻醉维持芬太尼0.03μg.kg-1.min-1;两组麻醉维持丙泊酚血浆靶浓度为3～5 mg.L-1。观察麻醉诱导前(T1)、插管前即刻(T2)、插管后即刻(T3)、插管后3 min(T4)、手术探查即刻(T5)、拔管后即刻(T6)、拔管后3 min(T7)患者的MAP、HR、血浆皮质醇(Cor)、血糖(Glu)的变化、麻醉恢复情况,随访术后延迟性呼吸抑制、术中知晓情况。结果与T1时比较,两组T2、T4时MAP和T4时HR均明显降低(P0.05或P0.01),F组T6时Cor和T3、T5、T6时Glu均显著升高(P0.05或P0.01);与SF组比较,F组T3、T6时MAP和T3时HR显著升高(P0.05),F组T5、T6时Cor和T6时Glu显著升高(P0.05或P0.01);SF组拔管期间体动、呛咳的发生率显著低于F组(P0.05),两组呼吸恢复时间、睁眼时间、拔管时间组间比较差异无统计学差异(P0.05)。结论对高血压全麻患者,靶控输注舒芬太尼与丙泊酚能更有效地减轻术中应激反应,维持血流动力学稳定,有助于提高全麻的安全性。

Effects of anesthesia with target-controlled infusion of sufentanil and propofol on stress response of hypertension patients

Objective To investigate the effects of stress response in hypertension patients during anesthesia with target-controlled infusion（TCI）of sufentanil and propofol.Methods Forty hypertension patients were scheduled for abdominal operation by general anesthesia.All patients were randomly assigned to two groups： Group sufentanil（SF） received TCI with sufentanil 0.5 μg·L-1 and propofol 3~5 mg·L-1 during induction and maintenance of anesthesia;Group fentanyl（F） fentanyl 4 μg·kg-1 and TCI of propofol 3.5 mg·L-1 during induction,fentanyl 0.03 μg·kg-1·min-1 and TCI of propofol 3~5 mg·L-1 during maintenance of anesthesia.MAP,HR and the values of cortisol（Cor） and blood glucose（Glu） were recorded at the time points of before induction（T1）,pre-intubation（T2）,intubation（T3）,3 min after intubation（T4）,surgical exploration（T5）,extubation（T6）,3 min after extubation（T7）.Anesthesia recovery,delayed respiratory depression and intraoperative awareness were recorded as well.Results Compared to those at T1,MAP at T2,T4 and HR at T4 of two groups showed significant decrease（P 0.05 or P 0.01）.The values of Cor at T6 and Glu at T3,T5,T6 in Group F had a significant increase than those at T1（P 0.05 or P 0.01）.MAP at T3,T6,HR at T3 and the values of Cor at T5,T6 and Glu at T6 in Group F had a significant increase compared with those in group SF at according time points（P 0.05 or P 0.01）.Incidence of body movement and coughing during extubation was lower in Group SF than those in Group F（P 0.05）.There was no significant difference in the recovery time from anesthesia between two groups.Conclusion Anesthesia with TCI of sufentanil and propofol of the hypertension patients is more effective in attenuating stress response and with better hemodynamic stability than fentanyl.