丙泊酚麻醉对妇科微创手术病人术中皮质醇和血糖水平的影响
Effect of propofol anesthesia on the levels of Cor and blood glucose in female patients treated with minimally invasive surgery
-
摘要: 目的：分析丙泊酚麻醉对妇科微创手术病人术中皮质醇（Cor）和血糖水平的影响。方法：收集行腹腔镜下子宫肌瘤切除术治疗的病人60例，随机分为七氟醚组和丙泊酚组，各30例。七氟醚组于麻醉诱导后吸入七氟醚；丙泊酚组靶控输注丙泊酚。比较2组病人建立气腹前（T1）和建立气腹后10 min（T2）、30 min（T3）及术毕（T4）时的平均动脉压（MAP）、心率（HR）和Cor、血糖、胰岛素、C肽、胰高血糖素（Glu）水平。结果：2组病人麻醉时间、自主呼吸恢复时间、睁眼时间、拔管时间、手术时间和清醒时间差异均无统计学意义（P>0.05）；术中输注胶体液量、输液总量、使用血管活性药物例数及阿片类药物使用量差异亦均无统计学意义（P>0.05）。2组病人不同时间点的MAP、HR差异均无统计学意义（P>0.05）；T2、T3、T4时的Cor、血糖、胰岛素、Glu水平均高于T1（P<0.05~P<0.01）。丙泊酚组T1时的Cor、血糖、胰岛素、C肽和Glu水平与七氟醚组差异均无统计学意义（P>0.05）；T2时血糖、Glu水平均低于七氟醚组，C肽水平高于七氟醚组（P<0.05）；T3、T4时Cor、血糖、Glu水平均低于七氟醚组，胰岛素、C肽水平均高于七氟醚组（P<0.05~P<0.01）。结论：丙泊酚和七氟醚均可有效维持腹腔镜子宫肌瘤切除术病人术中血流动力学稳定，但丙泊酚可以促进病人术中C肽和胰岛素的分泌，抑制了术中Glu、Cor过度分泌及血糖过度升高，相较于七氟醚，丙泊酚减轻术中应激反应的效果更佳。Abstract: Objective:To analyze the effects of propofol anesthesia on the levels of cortisol(Cor) and blood glucose in female patients treated with minimally invasive surgery.Methods:Sixty patients treated with laparoscopic myomectomy were divided into the sevoflurane group(n=30) and propofol group(n=30) according to the random number table method.After anesthesia induction,the sevoflurane was inhaled in sevoflurane group,and the propofol was infused in propofol group.The levels of mean arterial pressure(MAP),heart rate(HR),cortisol(Cor),blood glucose,insulin,C peptide,glucagon(Glu) between two groups were compared at the establishment of pneumoperitoneum(T1) and after 10 min and 30 min of pneumoperitoneum(T2 and T3) and during surgery(T4).Results:The differences of the anesthesia time,opening eye time,operation time and awaking time between two groups were not statistically significant(P>0.05).The differences of the anesthesia time,opening eye time,operation time and awaking time between two groups were not statistically significant(P>0.05).The differences of the amount of colloidal fluid,total fluid infusion volume,number of vasoactive drug use and amount of opioid use between two groups were not statistically significant(P>0.05).The differences of the levels of MAP and HR between two groups at different time-points were not statistically significant(P>0.05).The levels of Cor,blood glucose,insulin,C peptide and Glu in two groups at T2,T3 and T4 were higher than those at T1(P<0.05 to P<0.01).At T1,the differences of the levels of Cor,blood glucose,insulin,C peptide and Glu between two groups were not statistically significant(P>0.05).At T2,the levels of blood glucose and Glu in propofol group were lower than those in sevoflurane group,and the level of C peptide in propofol group was higher than that in sevoflurane group(P<0.05).At T3 and T4,the levels of Cor,blood glucose and Glu in propofol group were lower than those in sevoflurane group,and the levels of insulin and C peptide in propofol group were higher than that in sevoflurane group(P<0.05 to P<0.01).Conclusions:Propofol and sevoflurane can effectively maintain the stabilization of hemodynamics in patients treated with laparoscopic myomectomy.The propofol can promote the secretion of C peptide and insulin,and inhibit the excessive secretion of Glu,Cor and hyperglycemia during operation.Compared with sevoflurane,the effect of propofol on reducing the intraoperative stress response is better.
-
Key words:
- anesthesia /
- laparoscopic myomectomy /
- propofol /
- cortisol /
- stress hyperglycemia /
- stress response
-
[1] 宋萌颖,李丽娜.腹腔镜与小切口手术及传统手术治疗子宫肌瘤的临床疗效比较[J].山东医药,2014,54(17):66. [2] 鲍瑞军,张佩军,张庆.七氟醚或丙泊酚复合瑞芬太尼对妇科腹腔镜手术病人血流动力学的影响[J].山东医药,2012,52(44):61. [3] 邓超,代志刚,董希伟,等.七氟醚和丙泊酚麻醉对腹腔镜全子宫切除术病人应激反应影响[J].中华实用诊断与治疗杂志,2011,25(6):591. [4] KUNISAWA T,HANADA S,KUROSAWA A,et al.Dexmedetomidine was safely used for sedation during spinal anesthesia in a very elderly patient[J].J Anesth,2010,24(6):938. [5] 林峰.不同麻醉方法对老年腹腔镜手术肾素、皮质醇的影响[J].中国实验诊断学,2010,14(12):2036. [6] 刘阳.手术应激对兔和患儿血清中ACTH、Cor和IL-6的影响及意义[D].郑州:郑州大学,2010. [7] ATICI S,ARIBOGAN A.Comparison of the effects of sevoflurane and total intravenous anaesthesia in percutaneous nephrolithotomy[J].Eur J Anaesthesiol,2003,20(8):653. [8] 方吉,殷霞丽,张立,等.丙泊酚和七氟醚对手术应激反应作用的Meta分析[J].中国医院药学杂志,2013,33(7):558. [9] KONDO Y,HIROSE,MAEDA T,et al.Changes in Cerebral Blood Flow and Oxygenation During Induction of General Anesthesia with Sevoflurane Versus Propofol[J].Adv Exp Med Biol,2016,876:479. [10] 戴启明.丙泊酚减轻颈丛麻醉甲状腺手术中应激反应效果观察[J].中国医药导刊,2012,14(10):1753. [11] 唐珩,衡新华,刘星玲.七氟醚与丙泊酚静脉麻醉在小儿唇腭裂修复术中心率变异指数和血糖变化的对比研[J].中国医师杂志,2010,12(6):842. [12] SATO K,KITAMURA T,KAWAMURA G,et al.Glucose use in fasted rats under sevoflurane anesthesia and propofol anesthesia[J].Anesth Analg,2013,117(3):627. [13] WIEDEMANN M,GURROLA-DÍAZ CM,VARGAS-GUERRERO B,et al.Lupanine Improves Glucose Homeostasis by Influencing KATP Channels and Insulin Gene Expression[J].Molecules,2015,20(10):19085. [14] ASSAD AR,DELOU JM,FONSECA LM,et al.The role of KATP channels on propofol preconditioning in a cellular model of renal ischemia-reperfusion[J].Anesth Analg,2009,109(5):1486. -
点击查看大图
计量
- 文章访问数: 3522
- HTML全文浏览量: 396
- PDF下载量: 12
- 被引次数: 0
下载:
