【摘要】 目的探讨全身麻醉下吸烟病人体温与体温调节性周围血管收缩反应的变化。方法全身麻醉下行择期开腹手术的成年男性病人23例(ASA1-2级),分为吸烟组(S组,n=12)与对照组(C组,n=11)。S组患者烟龄13.58±8.38年、吸烟量17.08±5.82支/日,C组患者无吸烟史,其他情况同S组;两组麻醉诱导相同,即用丙泊酚1-2mg/kg、芬太尼4μg/kg、维库溴铵0.1mg/kg,气管插管后行间歇正压通气(IPPV),维持PETCO235-40mmHg,麻醉维持用1-2%异氟烷,0.08-0.12μg/kg/min瑞芬太尼,0.1-0.2mg/kg/h维库溴铵;监测食道温(TES)、平均皮肤温(TMSK)、前臂-指尖皮肤温度差(TFOR-FIN)。以TFOR-FIN=0℃时的TES作为体温调节性周围血管收缩阀值(threshold),以阈值下TES与TFOR-FIN间的线性回归斜率作为其增益(gain)。结果两组患者一般情况、血流动力学指标及麻醉诱导前(T0)TES、TMSK、食道-平均皮肤温度差(TES-MSK)、TFOR-FIN无统计学差异(P>0.05);TES:与T0比,C组T20至T180、S组T10至T180显著下降(P<0.05、P<0.01);组间比较,S组T20至T180显著低于C组(P<0.05、P<0.01),S组threshold显著低于C组(P<0.01)。结论全身麻醉下长期吸烟病人食道温及体温调节性血管收缩阈值显著下降,易出现低体温的并发症,全身麻醉时对吸烟病人更应加强体温的监测与管理。更多还原

【Abstract】 Objective To explore the changes of the temperature and the thermoregulatory peripheral vasoconstriction in smoking patients under general anesthesia.Methods 23 adult male patients undergoing abdominal operation under general anesthesia(ASA1-2),were divided into current smokers(group S,n=12,17.08±5.82cigarettes/day for13.58±8.38years)and nonsmokers control group(group C,n=11).Demographic data was similar in the two groups.Both groups of patients were administered with propofol1-2 mg/kg,fentanyl 4μg/kg and vecuronium 0.1 mg/kg for general anesthesia induction,followed by isoflurane 1%-2%,remifentanil 0.08-0.12μg/kg/min and vecuronium 0.1-0.2mg/kg/h for anesthesia maintenance.;After trachea intubation,all patients were received intermittent positive pressure ventilation(IPPV)and the PETCO2 were maintained between 35-40 mmHg.The esophageal temperature(TES),mean skin temperature(TMSK),and forearm-fingertip temperature gradient(TFOR-FIN)were recorded.A forearm-fingertip temperature gradient of 0(TFOR-FIN=0℃)was considered as onset of thermoregulatory vasoconstriction and the esophageal temperature(TES)that triggered the onset of vasoconstriction was defined as the thermoregulatory threshold.The slope of the linear regression of the forearm-fingertip temperature gradient-TESrelationship below the threshold was calculated as its gain(gain).Results There were no significant differences in hemodynamic parameters,TES,TMSK,esophageal-mean skin temperature gradient(TES-MSK)and TFOR-FINbefore anesthesia induction(T0)between the two groups(P>0.05);TES were significantly decreased from T20 to T180in group C and from T10 to T180in group S when compared to T0(P< 0.05,and P< 0.01,respectively).In addition,the TES were significantly lower in group S than that of group C fromT20 to T180(P<0.05,and P<0.01,respectively).The threshold value in group S was lower than that in group C(P<0.01).Conclusion long-term smoking patients have reduced esophageal temperature and thermoregulatory vasoconstriction threshold,and are prone to hypothermia complications during general anesthesia.It is sug-gested that smoker patients should be emphasized for temperature monitoring and management.更多还原