CAJ | 학술논문

目的比较不同ABO血型病人的应激反应.方法择期全麻病人A、B、AB、O血型各15例,年龄30～50岁,体重50～70 kg,根据血型分为A组、B组、AB组和O组.在气管插管诱发应激状态下观察应激反应水平,于麻醉诱导前即刻(基础状态)、气管插管即刻、气管插管后1、5、10 min时记录平均动脉压(MAP)和心率(HR),同时采集中心静脉血样5 ml,应用酶联免疫法测定血浆肾上腺素、去甲肾上腺素和多巴胺浓度,计算各时点测定值与基础值的差值以反映各指标变化幅度.结果与A组比较,B组、AB组和O组MAP、HR、血浆肾上腺素、去甲肾上腺素、多巴胺浓度的升高幅度降低(P<0.01);与AB组比较,B组和O组MAP、HR、血浆肾上腺素、去甲肾上腺素、多巴胺浓度的升高幅度降低(P<0.01);B组和O组各指标比较差异无统计学意义(P>0.05).结论 A型血病人应激反应明显强于其他血型病人,其次是AB型血病人,B型和O型血病人应激反应较弱.
목적 비교불동ABO혈형병인적응격반응.방법 택기전마병인A、B、AB、O혈형각15례,년령30～50세,체중50～70 kg,근거혈형분위A조、B조、AB조화O조.재기관삽관유발응격상태하관찰응격반응수평,우마취유도전즉각(기출상태)、기관삽관즉각、기관삽관후1、5、10 min시기록평균동맥압(MAP)화심솔(HR),동시채집중심정맥혈양5 ml,응용매련면역법측정혈장신상선소、거갑신상선소화다파알농도,계산각시점측정치여기출치적차치이반영각지표변화폭도.결과 여A조비교,B조、AB조화O조MAP、HR、혈장신상선소、거갑신상선소、다파알농도적승고폭도강저(P<0.01);여AB조비교,B조화O조MAP、HR、혈장신상선소、거갑신상선소、다파알농도적승고폭도강저(P<0.01);B조화O조각지표비교차이무통계학의의(P>0.05).결론 A형혈병인응격반응명현강우기타혈형병인,기차시AB형혈병인,B형화O형혈병인응격반응교약.
Objective To compare the stress response in patients of different ABO blood group.Methods Sixty patients of blood group A, B, AB and 0 (15 in each blood group), aged 30-50 yr, weighing 50-70 kg, scheduled for surgeries under general anesthesia were divided into 4 groups according to the blood group: group A, group B, group AB and group 0. The patients were premedicated with intramuscular scopolamine 0.3 mg. Anesthesia was induced with iv infusion of midazolam 0.05 mg/kg, propofol 1 mg/kg, fentanyl 4 μg/kg and succinylcholine 1.5 mg/kg. The patients were mechanically ventilated after tracheal intubation. BIS was maintained at 40-50. Anesthesia was maintained with iv infusion of propofol at 100μg·kg~(-1)·min~(-1) and remifentanil at 0.2 μg·kg~(-1)·min~(-1) and intermittent iv boluses of vecuronium 0.08 mg/kg. MAP and HR were monitored and recorded before induction of anesthesia (baseline, T_0) and at 0, 1, 5 and 10 min after tracheal intubation (T_(1-4) ) . Central venous blood samples were taken simultaneously to determine the plasma concentrations of epinephrine, norepinephrine and dopamine. Results The increasing amplitude in MAP, HR and plasma concentrations of epinephrine, norepinephrine and dopamine was significantly decreased in group B, AB and 0 compared with group A, and in group B and O compared with group AB (P < 0.01) . However, there were no significant difference in the each index between group B and group 0 ( P > 0.05 ) . Conclusion The stress response is the strongest in the patients of blood group A, followed by blood group AB and then blood group B and O.