七氟烷对后腹腔镜手术呼吸力学和血浆内皮素-1的影响

【摘要】 目的探讨七氟烷对后腹腔镜手术呼吸力学及血浆内皮素-1(ET-1)的影响。方法将80例后腹腔镜手术患者随机分为七氟烷-瑞芬太尼组(SR组)和丙泊酚-瑞芬太尼组(PR组),每组40例。静脉缓慢注射芬太尼3~5μg/kg、依托咪酯0.15~0.30 mg/kg、顺式阿曲库铵0.2 mg/kg进行麻醉诱导,术中SR组维持呼气末七氟烷为1.3 MAC,PR组维持丙泊酚6~10 mg/(kg·h),2组均泵注瑞芬太7~12μg/(kg·h),按时追加顺式阿曲库铵0.05 mg/kg。监测并记录诱导后5 min(T1)、侧卧位气腹前(T2)、气腹后15 min(T3)、30 min(T4)、45 min(T5)、解除气腹后10 min(T6)的气道峰压(Ppeak)、动态肺顺应性(Cdyn)、呼吸末二氧化碳分压(PETCO2),T1、T4、T6时刻的血浆ET-1。结果 T3、T4、T5时SR组的Ppeak(22.5±2.2)、(23.4±2.1)、(22.9±1.7)cm H2O(1 cm H2O=0.098 k Pa)明显低于PR组(25.2±2.2)、(25.3±2.1)、(25.3±2.6)cm H2O(P<0.05),Cdyn(28±4)、(27±5)、(27±47)cm H2O明显高于PR组(24±3)、(24±3)、(24±3)m L/cm H2O(P<0.05);血浆ET-1在T4、T6时SR组(65±5)、(61±6)ng/L均显著低于PR组(84±6)、(79±7)ng/L(P<0.05),2组血浆ET-1在T1时差异无统计学意义。结论七氟烷能更有效减轻后腹腔镜气腹对呼吸力学的影响和抑制血浆内皮素-1分泌。更多还原

【Abstract】 Objective To explore the effect of sevoflurane on respiratory mechanics and plasma Endothelin-1(ET-1) in patients undergoing retroperitoneoscopic operation. Methods Eighty patients undergoing elective retorperitoneal laparoscopic operation, were random Ly divided into two groups,40 patients in each group. Slowly intravenous injection of fentanyl 3-5 μg/kg,etomidate 0.15-0.30 mg/kg, Cis-atracurium 0.2 mg/kg anesthesia induction, intraoperative SR group keep out at the end of the 1.3 MAC sevoflurane, PR group maintain propofol 6-10 mg/(kg·h), two groups are pumping remifentaini 7-12 μg/(kg·h), timely supplementary cis-atracurium 0.05 mg/kg. Peak of airway pressure(Ppeak), dynamic compliance(Cdyn) and End-tidal CO2 pressure(PETCO2) were monitored and recorded 5 min after induction(T1), Lateral position and pre-pneumoperitoneum(T2), 15 min(T3), 30 min(T4) and 45 min(T5) after pneumoperitoneum, 10 min after reversal of pneumoperitoneum(T6). Results The Ppeak at T3,T4,T5 in group SR was Significantly lower than that at corresponding time point in group PR(P<0.05) [(22.5±2.2),(23.4±2.1),(22.9±1.7)cm H2 O vs(25.2±2.2),(25.3±2.1),(25.3±2.6)cm H2O](1 cm H2O=0.098 k Pa); the Cdyn at T3, T4, T5 in group SR was Significantly higher than that at corresponding time point in group PR(P<0.05) [(28±4),(27±5),(27±4)m L/cm H2 O vs(24±3),(24±3),(24±3)m L/cm H2O]; plasma ET-1 at T4, T6 in group SR was Significantly lower than that at corresponding time point in group PR(P<0.05) [(65±5),(61±6) ng/L vs(84±6),(79±7)ng/L], plasma ET-1 at T1 has no statistically significant difference between two groups. Conclusion Sevoflurane compared with propofol which can effectively alleviate after retroperitoneoscopic operation pneumoperitoneum on respiratory mechanics the influence and suppress the plasma endothelin-1 of secretion.更多还原