当代医学
噹代醫學
당대의학
CHINA CONTEMPORARY MEDICINE
2015年
10期
1-2,3
,共3页
王鑫宇%吕洁萍%张文凯%张利佳
王鑫宇%呂潔萍%張文凱%張利佳
왕흠우%려길평%장문개%장리가
后腹腔镜%七氟烷%呼吸力学%内皮素-1
後腹腔鏡%七氟烷%呼吸力學%內皮素-1
후복강경%칠불완%호흡역학%내피소-1
Retroperitoneoscopy%Sevoflurane%Respiratory mechanics%Endothelin-1
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(T 1)、侧卧位气腹前(T 2)、气腹后15 min(T 3)、30 min(T 4)、45 min(T 5)、解除气腹后10 min(T 6)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) cmH 2O(1 cmH 2O=0.098 kPa)明显低于PR组(25.2±2.2)、(25.3±2.1)、(25.3±2.6)cmH 2O(P<0.05)，Cdyn(28±4)、(27±5)、(27±47)cmH 2O明显高于PR组(24±3)、(24±3)、(24±3)mL/cmH 2O(P<0.05)；血浆ET-1在T 4、T 6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。
目的：探討七氟烷對後腹腔鏡手術呼吸力學及血漿內皮素-1(ET-1)的影響。方法將80例後腹腔鏡手術患者隨機分為七氟烷-瑞芬太尼組(SR組)和丙泊酚-瑞芬太尼組(PR組)，每組40例。靜脈緩慢註射芬太尼3～5μg/kg、依託咪酯0.15～0.30 mg/kg、順式阿麯庫銨0.2 mg/kg進行痳醉誘導，術中SR組維持呼氣末七氟烷為1.3 MAC，PR組維持丙泊酚6～10 mg/(kg·h)，2組均泵註瑞芬太7～12μg/(kg·h)，按時追加順式阿麯庫銨0.05 mg/kg。鑑測併記錄誘導後5 min(T 1)、側臥位氣腹前(T 2)、氣腹後15 min(T 3)、30 min(T 4)、45 min(T 5)、解除氣腹後10 min(T 6)的氣道峰壓(Ppeak)、動態肺順應性(Cdyn)、呼吸末二氧化碳分壓（PETCO2），T1、T4、T6時刻的血漿ET-1。結果 T3、T4、T5時SR組的Ppeak(22.5±2.2)、(23.4±2.1)、(22.9±1.7) cmH 2O(1 cmH 2O=0.098 kPa)明顯低于PR組(25.2±2.2)、(25.3±2.1)、(25.3±2.6)cmH 2O(P<0.05)，Cdyn(28±4)、(27±5)、(27±47)cmH 2O明顯高于PR組(24±3)、(24±3)、(24±3)mL/cmH 2O(P<0.05)；血漿ET-1在T 4、T 6時SR組(65±5)、(61±6)ng/L均顯著低于PR組(84±6)、(79±7)ng/L(P<0.05)，2組血漿ET-1在T1時差異無統計學意義。結論七氟烷能更有效減輕後腹腔鏡氣腹對呼吸力學的影響和抑製血漿內皮素-1分泌。
목적：탐토칠불완대후복강경수술호흡역학급혈장내피소-1(ET-1)적영향。방법장80례후복강경수술환자수궤분위칠불완-서분태니조(SR조)화병박분-서분태니조(PR조)，매조40례。정맥완만주사분태니3～5μg/kg、의탁미지0.15～0.30 mg/kg、순식아곡고안0.2 mg/kg진행마취유도，술중SR조유지호기말칠불완위1.3 MAC，PR조유지병박분6～10 mg/(kg·h)，2조균빙주서분태7～12μg/(kg·h)，안시추가순식아곡고안0.05 mg/kg。감측병기록유도후5 min(T 1)、측와위기복전(T 2)、기복후15 min(T 3)、30 min(T 4)、45 min(T 5)、해제기복후10 min(T 6)적기도봉압(Ppeak)、동태폐순응성(Cdyn)、호흡말이양화탄분압（PETCO2），T1、T4、T6시각적혈장ET-1。결과 T3、T4、T5시SR조적Ppeak(22.5±2.2)、(23.4±2.1)、(22.9±1.7) cmH 2O(1 cmH 2O=0.098 kPa)명현저우PR조(25.2±2.2)、(25.3±2.1)、(25.3±2.6)cmH 2O(P<0.05)，Cdyn(28±4)、(27±5)、(27±47)cmH 2O명현고우PR조(24±3)、(24±3)、(24±3)mL/cmH 2O(P<0.05)；혈장ET-1재T 4、T 6시SR조(65±5)、(61±6)ng/L균현저저우PR조(84±6)、(79±7)ng/L(P<0.05)，2조혈장ET-1재T1시차이무통계학의의。결론칠불완능경유효감경후복강경기복대호흡역학적영향화억제혈장내피소-1분비。
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 randomLy divided into two groups,40 patients in each group. Slowly intravenous injection of fentanyl 3-5μg/kg,etomidate 0.15-0.30mg/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 6-10mg/(kg·h), two groups are pumping remifentaini 7-12μg/(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 5min after induction (T1), Lateral position and pre-pneumoperitoneum (T2), 15min (T3), 30min (T4) and 45min (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 H2O vs (25.2±2.2),(25.3±2.1),(25.3±2.6)cmH2O] (1cmH2O=0.098 kPa); 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)mL/cm H2O vs (24±3),(24±3),(24±3)mL/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.
