中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2010年
27期
13-16
,共4页
刘海洋%陈彤岩%曾横宇%韩如泉
劉海洋%陳彤巖%曾橫宇%韓如泉
류해양%진동암%증횡우%한여천
麻醉,静脉%麻醉,吸入%血糖%氢化可的松%脊柱神经外科手术
痳醉,靜脈%痳醉,吸入%血糖%氫化可的鬆%脊柱神經外科手術
마취,정맥%마취,흡입%혈당%경화가적송%척주신경외과수술
Anesthesia,intravenous%Anesthesia,inhalation%Blood glucose%Hydrocortisone%Spinal neurosurgery
目的 探讨静吸复合麻醉和全凭静脉麻醉对脊柱神经外科手术患者血糖和皮质醇的影响.方法 将44例择期行脊柱神经外科手术患者根据计算机产生的随机表分为两组:普鲁泊福复合瑞芬太尼全凭静脉麻醉组(PR组)、七氟烷复合瑞芬太尼静吸复合麻醉组(SR组),每组22例.两组均以普鲁泊福、舒芬太尼、罗库溴铵诱导麻醉,SR组以七氟烷吸入维持麻醉,PR组以普鲁泊福维持麻醉,使脑电双频指数稳定于45～55.观察两组患者不同时间点血糖、皮质醇及血流动力学变化情况.结果 诱导后PR组平均动脉压(MAP)高于SR组(P＜0.05);PR组诱导后60min MAP低于诱导前(P＜0.05).PR组和SR组诱导后60、120min心率(HR)均低于诱导前(P＜0.05);诱导后5min PR组HR低于SR组(P＜0.05).两组间及两组内各时间点血糖水平、两组间各时间点皮质醇水平比较,差异均无统计学意义(P＞0.05).PR组诱导后120min皮质醇水平[(40.6±18.3)μg/L]较诱导前[(129.7±36.7)μg/L]显著降低(P＜0.05),术毕24 h[(93.6±19.8)μg/L]恢复至诱导前水平;SR组诱导后120 min皮质醇水平[(51.6±16.8)μg/L]较诱导前[(130.5±32.1)μg/L]显著降低(P＜0.05),并持续至术毕24 h[(75.9±18.2)μg/L].结论 两种方法均可用于脊柱神经外科手术的麻醉维持,围手术期血糖水平无明显波动,但是七氟烷对皮质醇的抑制时间可能更长.
目的 探討靜吸複閤痳醉和全憑靜脈痳醉對脊柱神經外科手術患者血糖和皮質醇的影響.方法 將44例擇期行脊柱神經外科手術患者根據計算機產生的隨機錶分為兩組:普魯泊福複閤瑞芬太尼全憑靜脈痳醉組(PR組)、七氟烷複閤瑞芬太尼靜吸複閤痳醉組(SR組),每組22例.兩組均以普魯泊福、舒芬太尼、囉庫溴銨誘導痳醉,SR組以七氟烷吸入維持痳醉,PR組以普魯泊福維持痳醉,使腦電雙頻指數穩定于45～55.觀察兩組患者不同時間點血糖、皮質醇及血流動力學變化情況.結果 誘導後PR組平均動脈壓(MAP)高于SR組(P＜0.05);PR組誘導後60min MAP低于誘導前(P＜0.05).PR組和SR組誘導後60、120min心率(HR)均低于誘導前(P＜0.05);誘導後5min PR組HR低于SR組(P＜0.05).兩組間及兩組內各時間點血糖水平、兩組間各時間點皮質醇水平比較,差異均無統計學意義(P＞0.05).PR組誘導後120min皮質醇水平[(40.6±18.3)μg/L]較誘導前[(129.7±36.7)μg/L]顯著降低(P＜0.05),術畢24 h[(93.6±19.8)μg/L]恢複至誘導前水平;SR組誘導後120 min皮質醇水平[(51.6±16.8)μg/L]較誘導前[(130.5±32.1)μg/L]顯著降低(P＜0.05),併持續至術畢24 h[(75.9±18.2)μg/L].結論 兩種方法均可用于脊柱神經外科手術的痳醉維持,圍手術期血糖水平無明顯波動,但是七氟烷對皮質醇的抑製時間可能更長.
목적 탐토정흡복합마취화전빙정맥마취대척주신경외과수술환자혈당화피질순적영향.방법 장44례택기행척주신경외과수술환자근거계산궤산생적수궤표분위량조:보로박복복합서분태니전빙정맥마취조(PR조)、칠불완복합서분태니정흡복합마취조(SR조),매조22례.량조균이보로박복、서분태니、라고추안유도마취,SR조이칠불완흡입유지마취,PR조이보로박복유지마취,사뇌전쌍빈지수은정우45～55.관찰량조환자불동시간점혈당、피질순급혈류동역학변화정황.결과 유도후PR조평균동맥압(MAP)고우SR조(P＜0.05);PR조유도후60min MAP저우유도전(P＜0.05).PR조화SR조유도후60、120min심솔(HR)균저우유도전(P＜0.05);유도후5min PR조HR저우SR조(P＜0.05).량조간급량조내각시간점혈당수평、량조간각시간점피질순수평비교,차이균무통계학의의(P＞0.05).PR조유도후120min피질순수평[(40.6±18.3)μg/L]교유도전[(129.7±36.7)μg/L]현저강저(P＜0.05),술필24 h[(93.6±19.8)μg/L]회복지유도전수평;SR조유도후120 min피질순수평[(51.6±16.8)μg/L]교유도전[(130.5±32.1)μg/L]현저강저(P＜0.05),병지속지술필24 h[(75.9±18.2)μg/L].결론 량충방법균가용우척주신경외과수술적마취유지,위수술기혈당수평무명현파동,단시칠불완대피질순적억제시간가능경장.
Objective To investigate the effects of total intravenous anesthesia (TIVA) and combined intravenous and inhalation anesthesia on blood glucose and cortisol in spinal neurosurgery.Methods Forty-four spinal neurosurgery patients were divided into propofol combined with remifentanil group (PR group) and sevoflurane combined with remifentanil group (SR group ), 22 cases in each group,they were induced with propofol, sufentanil and rocuronium. Anesthesia was maintained with sevoflurane in SR group while propofol in PR group. Depth of anesthesia adaption according to bispectral index (BIS)(45 -55). Blood glucose, cortisol, haemodynamics were observed at different time points. Results The mean arterial pressure(MAP) was higher after induction in PR group than that in SR group(P ＜ 0.05 ). Sixty minutes after induction, MAP was lower than that before induction in PR group (P ＜ 0.05 ). Heart rate ( HR )in both SR group and PR group were lower at 60 and 120 minutes after induction than those before induction (P ＜ 0.05). HR was lower at 5 minutes after induction in PR group than that in SR group (P ＜ 0.05). No significant difference was showed in blood glucose and cortisol between the two groups (P ＞ 0.05 ). Cortisol level was significantly lower at 120 minutes after induction than that before induction [(40.6 ± 18.3) μg/L vs. ( 129.7 ± 36.7 ) μg/L, P ＜ 0.05 ] and at 24 hours postoperative [ (93.6 ± 19.8 ) μg/L ] recovered to the level before induction in PR group. Cortisol level was significantly higher before induction than 120 minutes after induction [ ( 130.5 ± 32.1 ) μg/L vs. (51.6 ± 16.8 ) μg/L, P ＜ 0.05 ] and 24 hours postoperative was (75.9 ± 18.2) μg/L in SR group. Conclusions Two anesthetic regimens are compatible during spinal neurosurgery, with no apparent fluctuations of perioperative blood glucose. However, longer cortisol inhibition is probably happened when using sevoflurane.
