CAJ | 학술논문

目的：研究两种麻醉药物组合行控制性降压时不同时间点对脊柱手术患者应激反应的影响和血流动力学的变化。方法A杂AⅠ~Ⅱ级，择期全身麻醉下俯卧位拟行腰椎间盘摘除椎弓根内固定手术的患者40例。随机分为两组各20例。七氟醚复合舒芬太尼降压组(A组)，丙泊酚复合舒芬太尼降压组(B组)。目标血压是MAP较术前基础值下降25%~30%，降压时间为2h。应用心电监护仪和云造燥T则葬糟系统监测并记录病人入手术室安静时(T1)、降压达目标值时(T2)、降压后1h(T3)、降压后2h(T4)、停降压后5min(T5)和10min(T6)的平均动脉压(MAP)、心率(HR)、心排血量(CO)、每搏量(SV)、心指数(CI)等数值的变化。于T3、T4两个时间点抽取桡动脉血行床边血气分析；并在T3、T4、T5、T6抽取外周静脉血，留取血标本测血浆中内皮素(ET)和血栓素月2(TXB2)的含量。结果两组血流动力学参数在T2、T3、T4时点组内组间比较均无明显差异，与T1相比MAP、CO、CI、SV显著降低(P<0.05)，两组T5、T6时与T4相比显著升高(P<0.05)，MAP值组内T5<T6，组间A组<B组(P<0.05)，有统计学意义。内皮素和血栓素B2含量两组在T3、T4、T5、T6时均逐渐升高，A组<B组(P<0.05)。研究过程中两组的心率无明显变化。结论七氟醚复合舒芬太尼行控制性降压与丙泊酚复合舒芬太尼相比，能有效抑制与应激反应相关的内皮素和血栓素B2水平的增加，可降低停药后反跳性高血压的发生，减少并发症的发生。
목적：연구량충마취약물조합행공제성강압시불동시간점대척주수술환자응격반응적영향화혈류동역학적변화。방법A잡AⅠ~Ⅱ급，택기전신마취하부와위의행요추간반적제추궁근내고정수술적환자40례。수궤분위량조각20례。칠불미복합서분태니강압조(A조)，병박분복합서분태니강압조(B조)。목표혈압시MAP교술전기출치하강25%~30%，강압시간위2h。응용심전감호의화운조조T칙장조계통감측병기록병인입수술실안정시(T1)、강압체목표치시(T2)、강압후1h(T3)、강압후2h(T4)、정강압후5min(T5)화10min(T6)적평균동맥압(MAP)、심솔(HR)、심배혈량(CO)、매박량(SV)、심지수(CI)등수치적변화。우T3、T4량개시간점추취뇨동맥혈행상변혈기분석；병재T3、T4、T5、T6추취외주정맥혈，류취혈표본측혈장중내피소(ET)화혈전소월2(TXB2)적함량。결과량조혈류동역학삼수재T2、T3、T4시점조내조간비교균무명현차이，여T1상비MAP、CO、CI、SV현저강저(P<0.05)，량조T5、T6시여T4상비현저승고(P<0.05)，MAP치조내T5<T6，조간A조<B조(P<0.05)，유통계학의의。내피소화혈전소B2함량량조재T3、T4、T5、T6시균축점승고，A조<B조(P<0.05)。연구과정중량조적심솔무명현변화。결론칠불미복합서분태니행공제성강압여병박분복합서분태니상비，능유효억제여응격반응상관적내피소화혈전소B2수평적증가，가강저정약후반도성고혈압적발생，감소병발증적발생。
Objective To explore the impact of combination of two kinds of anesthetic drug for controlled hypotension during spinal surgery on the stress response and hemodynamic changes of patients with spinal surgery. Methods 40 patients with selected lumbar discectomy and pedicle screw fixation under general anesthesia were selected and randomly divided into two groups, with 20 cases in each group. Group A received sevoflurane combined with sufentanil hypotension, and group B received propofol combined with sufentanil hypotension. Target blood pressure was MAP decreased by 25%to 30%compared with preoperative baseline, and the antihypertensive time was 2 hours. The changes of mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), stroke volume (SV) and cardiac index (CI) at the time when patients be quiet after entering operating room (T1), at the time when antihypertensive reached the target (T2), at 1 hour of antihypertension (T3), at 2 hours of antihypertensive (T4), at 5 min (T5) and 10 min (T6) after stopping antihypertension were monitored by ECG and FloTrac system. Bedside blood gas analysis was taken at T3 and T4. The levels of plasma endothelin (ET) and thromboxane B2 (TXB2) at T3, T4, T5 and T6 were detected. Results There were no statistical differences in hemodynamic parameters at T2, T3 and T4 by comparison within-groups and inter-groups;Compared with parameters at T1, MAP, CO, CI and SV at T2, T3 and T4 decreased significantly (P<0.05), and compared with parameters at T2, all the parameters above increased significantly at T5 and T6 (P <0.05). MAP level: T5< T6 comparison inter-groups, and group A<group B comparison within groups (P<0.05). Both ET level and TXB2 level at T3, T4, T5 and T6 increased gradually, and group A < group B comparison within groups (P <0.05). No significant change in heart rate was found in both groups. Conclusions Sevoflurane combined with sufentanil hypotension for controlled hypotension during spinal surgery can effectively inhabit the increase of ET and TXB2 associated with the stress response, reduce the incidence of rebound hypertension after withdrawal, and reduce the incidence of complications.