中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2014年
12期
56-59
,共4页
老年人%丙泊酚%七氟醚%肺叶切除术%氧化性应激
老年人%丙泊酚%七氟醚%肺葉切除術%氧化性應激
노년인%병박분%칠불미%폐협절제술%양화성응격
Aged%Propofol%Sevoflurane%Lobectomy%Oxidative stress
目的 观察丙泊酚或七氟醚联合胸段硬膜外阻滞对老年肺叶切除术患者围手术期氧化应激反应的影响.方法 选择行肺叶切除术老年患者60例,ASA分级Ⅰ～Ⅲ级.采用随机数字表法分为丙泊酚全身麻醉联合胸段硬膜外阻滞组(P组)和七氟醚吸入麻醉联合胸段硬膜外阻滞组(S组),每组30例.P组靶控输注丙泊酚40～ 50 μg/ (kg·min)维持全身麻醉深度,S组持续吸入1％～2％的七氟醚维持全身麻醉深度.两组分别于入室后(T0)、单肺通气时(T1)、手术2 h(T2)、手术结束(T3)、术后2 h(T4)、术后24 h(T5)抽取静脉血测定丙二醛(MDA)、一氧化氮(NO)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)含量.结果 与T0时比较,两组T2时收缩压(SBP)、舒张压(DBP)和心率(HR)均降低,差异有统计学意义(P＜0.05).两组患者各时点SBP、DBP和HR比较差异均无统计学意义(P＞0.05).与T0时比较,T1、T2时P组和T1～ T5时S组血浆NO、MDA水平升高,T1～T5时S组血浆SOD和GSH-Px水平降低,差异有统计学意义(P＜0.05).与S组比较,T3～T5时P组血浆NO和MDA水平降低,而SOD和GSH-Px水平升高,差异有统计学意义(P＜0.05).结论 丙泊酚全身麻醉维持方式能更好地降低老年胸科手术患者的围手术期氧化应激水平,有利于术后恢复.
目的 觀察丙泊酚或七氟醚聯閤胸段硬膜外阻滯對老年肺葉切除術患者圍手術期氧化應激反應的影響.方法 選擇行肺葉切除術老年患者60例,ASA分級Ⅰ～Ⅲ級.採用隨機數字錶法分為丙泊酚全身痳醉聯閤胸段硬膜外阻滯組(P組)和七氟醚吸入痳醉聯閤胸段硬膜外阻滯組(S組),每組30例.P組靶控輸註丙泊酚40～ 50 μg/ (kg·min)維持全身痳醉深度,S組持續吸入1％～2％的七氟醚維持全身痳醉深度.兩組分彆于入室後(T0)、單肺通氣時(T1)、手術2 h(T2)、手術結束(T3)、術後2 h(T4)、術後24 h(T5)抽取靜脈血測定丙二醛(MDA)、一氧化氮(NO)、超氧化物歧化酶(SOD)、穀胱甘肽過氧化物酶(GSH-Px)含量.結果 與T0時比較,兩組T2時收縮壓(SBP)、舒張壓(DBP)和心率(HR)均降低,差異有統計學意義(P＜0.05).兩組患者各時點SBP、DBP和HR比較差異均無統計學意義(P＞0.05).與T0時比較,T1、T2時P組和T1～ T5時S組血漿NO、MDA水平升高,T1～T5時S組血漿SOD和GSH-Px水平降低,差異有統計學意義(P＜0.05).與S組比較,T3～T5時P組血漿NO和MDA水平降低,而SOD和GSH-Px水平升高,差異有統計學意義(P＜0.05).結論 丙泊酚全身痳醉維持方式能更好地降低老年胸科手術患者的圍手術期氧化應激水平,有利于術後恢複.
목적 관찰병박분혹칠불미연합흉단경막외조체대노년폐협절제술환자위수술기양화응격반응적영향.방법 선택행폐협절제술노년환자60례,ASA분급Ⅰ～Ⅲ급.채용수궤수자표법분위병박분전신마취연합흉단경막외조체조(P조)화칠불미흡입마취연합흉단경막외조체조(S조),매조30례.P조파공수주병박분40～ 50 μg/ (kg·min)유지전신마취심도,S조지속흡입1％～2％적칠불미유지전신마취심도.량조분별우입실후(T0)、단폐통기시(T1)、수술2 h(T2)、수술결속(T3)、술후2 h(T4)、술후24 h(T5)추취정맥혈측정병이철(MDA)、일양화담(NO)、초양화물기화매(SOD)、곡광감태과양화물매(GSH-Px)함량.결과 여T0시비교,량조T2시수축압(SBP)、서장압(DBP)화심솔(HR)균강저,차이유통계학의의(P＜0.05).량조환자각시점SBP、DBP화HR비교차이균무통계학의의(P＞0.05).여T0시비교,T1、T2시P조화T1～ T5시S조혈장NO、MDA수평승고,T1～T5시S조혈장SOD화GSH-Px수평강저,차이유통계학의의(P＜0.05).여S조비교,T3～T5시P조혈장NO화MDA수평강저,이SOD화GSH-Px수평승고,차이유통계학의의(P＜0.05).결론 병박분전신마취유지방식능경호지강저노년흉과수술환자적위수술기양화응격수평,유리우술후회복.
Objective To observe the influence of the oxidative stress reaction in elderly patients with lobectomy under epidural blockade combined with either propofol or sevoflurane.Methods Sixty elderly patients with lobectomy were enrolled in this study,ASA Ⅰ-Ⅲ grade.The patients were divided into propofol combined with epidural blockade group (group P,30 patients) and sevoflurane combined with epidural blockade group (group S,30 patients) by random digits table method.The depth of anesthesia in group P was kept by 40-50 μ g/ (kg ·min) propofol and in group S was kept by 1％-2％ sevoflurane continuous inhalation.The level of malondialdehyde (MDA),nitric oxide (NO),superoxide dismutase (SOD),glutathione peroxidase (GSH-Px) in two groups before surgery (T0),one lung ventilation (T1),2 h during surgery (T2),surgery end (T3),2 h postoperatively (T4) and 24 h postoperatively (T5) in venous blood were detected and compared.Results The level of systolic blood pressure (SBP),diastolic blood pressure (DBP) and heart rate (HR) at T2 was significantly decreased compared with T0 in two groups (P ＜ 0.05).The level of SBP,DBP and HR at every point had no significant difference between two groups (P ＞ 0.05).The level of NO and MDA were increased at T1,T2 in group P and T1-T5 in group S compared with T0,the level of SOD and GSH-Px at T1-T5 in group S were decreased compared with T0,there were significant differences (P ＜0.05).The level of NO and MDA at T3-T5 were decreased and the level of SOD and GSH-Px were increased in group P compared with those in group S,there were significant differences (P ＜0.05).Conclusion Propofol can reduce the oxidative stress reaction more effectively comparing with sevoflurane,and has some help on the prognosis of the elderly.
