海南医学
海南醫學
해남의학
Hainan Medical Journal
2015年
20期
3006-3008
,共3页
快通道麻醉%硬膜外阻滞麻醉%内皮素%降钙素基因相关肽
快通道痳醉%硬膜外阻滯痳醉%內皮素%降鈣素基因相關肽
쾌통도마취%경막외조체마취%내피소%강개소기인상관태
Fast-track anesthesia%Epidural block%Endothelin (ET)%Calcitonin gene-related peptide (CGRP)
目的 探讨快通道麻醉联合硬膜外阻滞麻醉对老年患者血浆内皮素(ET)及降钙素基因相关肽(CGRP)的影响.方法 32例接受外科手术治疗的老年患者随机分为观察组(n=16)和对照组(n=16),观察组给予静脉快通道麻醉联合硬膜外阻滞麻醉,对照组给予常规全身麻醉联合硬膜外阻滞麻醉,采用放射免疫法检测两组麻醉前(T0)、气管插管后5 min (T1)、切皮后5 min (T2)、手术探查时(T3)、术后拔管后(T4)血浆ET及CGRP,比较两组患者的血浆ET及CGRP水平.结果 观察组仅在T1时点血浆ET水平显著低于T0 (P<0.01),其他三个时点与T0比较差异均无统计学意义(P>0.05),而对照组麻醉后四个时点与麻醉前比较差异均具有显著统计学意义(P<0.01);观察组T3、T4两个时点的ET水平均显著高于对照组,差异均具有显著统计学意义(P<0.01);两组患者麻醉后的血浆CGRP水平均显著增高(P<0.05),同时麻醉后各时点观察组血浆CGRP水平均明显高于对照组,差异均具有统计学意义(P<0.05或P<0.01).结论 快通道麻醉与硬膜外阻滞麻醉联合应用能够有效降低血浆ET水平,减轻ET的血管收缩作用,同时能够增加CGRP的产生,对抗ET的缩血管作用,从而减轻老年患者麻醉、手术中的应激反应.
目的 探討快通道痳醉聯閤硬膜外阻滯痳醉對老年患者血漿內皮素(ET)及降鈣素基因相關肽(CGRP)的影響.方法 32例接受外科手術治療的老年患者隨機分為觀察組(n=16)和對照組(n=16),觀察組給予靜脈快通道痳醉聯閤硬膜外阻滯痳醉,對照組給予常規全身痳醉聯閤硬膜外阻滯痳醉,採用放射免疫法檢測兩組痳醉前(T0)、氣管插管後5 min (T1)、切皮後5 min (T2)、手術探查時(T3)、術後拔管後(T4)血漿ET及CGRP,比較兩組患者的血漿ET及CGRP水平.結果 觀察組僅在T1時點血漿ET水平顯著低于T0 (P<0.01),其他三箇時點與T0比較差異均無統計學意義(P>0.05),而對照組痳醉後四箇時點與痳醉前比較差異均具有顯著統計學意義(P<0.01);觀察組T3、T4兩箇時點的ET水平均顯著高于對照組,差異均具有顯著統計學意義(P<0.01);兩組患者痳醉後的血漿CGRP水平均顯著增高(P<0.05),同時痳醉後各時點觀察組血漿CGRP水平均明顯高于對照組,差異均具有統計學意義(P<0.05或P<0.01).結論 快通道痳醉與硬膜外阻滯痳醉聯閤應用能夠有效降低血漿ET水平,減輕ET的血管收縮作用,同時能夠增加CGRP的產生,對抗ET的縮血管作用,從而減輕老年患者痳醉、手術中的應激反應.
목적 탐토쾌통도마취연합경막외조체마취대노년환자혈장내피소(ET)급강개소기인상관태(CGRP)적영향.방법 32례접수외과수술치료적노년환자수궤분위관찰조(n=16)화대조조(n=16),관찰조급여정맥쾌통도마취연합경막외조체마취,대조조급여상규전신마취연합경막외조체마취,채용방사면역법검측량조마취전(T0)、기관삽관후5 min (T1)、절피후5 min (T2)、수술탐사시(T3)、술후발관후(T4)혈장ET급CGRP,비교량조환자적혈장ET급CGRP수평.결과 관찰조부재T1시점혈장ET수평현저저우T0 (P<0.01),기타삼개시점여T0비교차이균무통계학의의(P>0.05),이대조조마취후사개시점여마취전비교차이균구유현저통계학의의(P<0.01);관찰조T3、T4량개시점적ET수평균현저고우대조조,차이균구유현저통계학의의(P<0.01);량조환자마취후적혈장CGRP수평균현저증고(P<0.05),동시마취후각시점관찰조혈장CGRP수평균명현고우대조조,차이균구유통계학의의(P<0.05혹P<0.01).결론 쾌통도마취여경막외조체마취연합응용능구유효강저혈장ET수평,감경ET적혈관수축작용,동시능구증가CGRP적산생,대항ET적축혈관작용,종이감경노년환자마취、수술중적응격반응.
Objective To discuss the influence of intervenous fast-track anesthesia combined with epidural block on plasma endothelin (ET) and calcitonin gene-related peptide (CGRP) in elderly patients. Methods Thir-ty-two elderly patients accepted surgical operation were randomly divided into the observation group (n=16) and the control group (n=16). The observation group was given intervenous fast-track anesthesia combined with epidural block, and the control group was given routine general anesthesia combined with epidural block. Then levels of plas-ma ET and CGRP were detected with radioimmunoassay before anesthesia (T0), 5 min after anesthesia (T1), 5 min af-ter skin incision (T2), at time of intraoperative sonography (T3), after extubation (T4) in the two groups. Plasma ET and CGRP in the two groups were compared. Results Compared with T0, ET was significantly reduced only at T1 in the observation group (P<0.01), with no significant difference between the other three time points and T0 (P>0.05). In the control group, ET at the four time points (T1, T2, T3, T4) were significantly lower than that at T0 (P<0.01). ET levels at T3 and T4 in the observation group were significantly higher than those in the control group (P<0.01). CGRP was sig-nificantly increased in the two groups after anesthesia (P<0.05). CGRP in the observation group were significantly higher than that in the control group at any time point after anesthesia (P<0.05 or P<0.01). Conclusion Intervenous fast-track anesthesia combined with epidural anesthesia can effectively reduce the level of plasma ET, reduce vasocon-striction of ET, and can generate CGRP, antagonize the vasoconstrictive action of ET, thereby reduce the stress re-sponse to anesthesia and surgery in elderly patients.
