【摘要】 目的观察丙泊酚靶控输注(TCI)用于辅助硬膜外麻醉对围术期促肾上腺皮质激素(ACTH)、皮质醇、血糖及心率(HR)、平均动脉压(MAP)的影响。方法选择30例ASAⅠ~Ⅱ级,择期行子宫切除术的病人随机分为两组。Ⅰ组在硬膜外麻醉平面确定时丙泊酚TCI目标血药浓度1.5μg/ml;Ⅱ组作为对照组,单纯硬膜外麻醉,不使用TCI。于术前(T1)、术中(T2)、术毕(T3)抽取静脉血检测血糖、皮质醇、ACTH,同时记录各时点HR、MAP。结果Ⅰ组皮质醇随手术进程逐渐升高,但与基础值比无显著性差异,且在术中及术毕显著低于Ⅱ组;Ⅱ组皮质醇在术中及术毕显著高于基础值;Ⅰ、Ⅱ组ACTH在术中及术毕均显著升高,且Ⅱ组ACTH在术中及术毕均显著高于Ⅰ组。Ⅰ组血糖无显著变化,Ⅱ组血糖在术中术毕显著升高。结论丙泊酚可能通过抑制垂体ACTH释放的增加抑制皮质醇的分泌,从而避免了围术期过度的应激反应。更多还原

【Abstract】 Objective To evaluate the effect of propofol target（controlled） infusion（TCI） on stress response during epidural anesthesia.Methods Thirty ASA Ⅰ-Ⅱ patients undergoing hysterectomy were randomly allocated into group Ⅰ（propofol TCI of 1.5μg/ml during operation） and group Ⅱ（without propofol）.HR and MAP were recorded,and the concentration of blood glucose,serum cortisol,ACTH were determined before operation（T₁）,uterus removal（T₂） and at end of the surgery（T₃）.Results In group Ⅰ,serum ACTH slightly rised during operation,which was significantly lower than that In group Ⅱ.In group Ⅱ,serum cortisol at T₂ and T₃ was（significantly） higher than that at T₁. In both groups,ACTH was significantly rised at T₂ and T₃,which in group Ⅰ was significantly lower than that in group Ⅱ. Blood glucose at T₂ and T₃ was significantly higher than that at T₁ in group Ⅱ.（Conclusion）Propofol（restrained） the secretion of cortisol by inhibition of ACTH,which is beneficial to reducing excessive surgical stress response.更多还原