靶控输注依托咪酯乳剂对患者围术期应激反应的调控

靶控输注依托咪酯乳剂对患者围术期应激反应的调控

靶控输注依托咪酯乳剂对患者围术期应激反应的调控 【摘要】 目的 利用靶控输注的技术应用依托咪酯乳剂，研究其对患者围术期应激反应的调控。 方法 45例择期手术的患者随机分为三组，每组15例：Ⅰ组为对照组，不使用依托咪酯；Ⅱ组为依托咪酯持续静推组，Ⅲ组为依托咪酯靶控输注组。在麻醉前，插管后，切皮后，缝皮时，术后第1日清晨四个时点测皮质醇，血糖；停药后30min测静脉糖耐量试验。 结果 Ⅰ组术中各时点皮质醇水平高于正常值，Ⅱ组插管时皮质醇水平高于正常值，Ⅲ组各时点皮质醇水平在正常值范围内；Ⅱ、Ⅲ组皮质醇水平随给药时间延长而下降；所有患者术后第1日晨皮质醇恢复正常。Ⅰ组插管后血糖增高，停药后30min静脉糖耐量异常；Ⅱ、Ⅲ组血糖及糖耐量未见异常。 结论 麻醉中利用靶控输注的技术复合依托咪酯乳剂可更好地调控围术期应激反应。依托咪酯乳剂对术前糖代谢正常的患者术中糖代谢无明显影响。

　　【关键词】 麻醉;依托咪酯;药物投与系统;应激反应

　　The effects on neuroendocrine stress response with target controlled infusion system for etomidate

　　
　　【Abstract】 Objective To observe the effect on neuroendocrine stress response with target controlled infusion system for etomidate. Methods Fourty-five patients underwent selective operation were divided into 3 groups, 15cases in each group: Group Ⅰ was contrasting group, use no etomidate; Group Ⅱ was the group of etomidate with continue infusion; Group Ⅲ was the group of etomidate with target controlled infusion (TCI). Monitor the changes of cortisol and blood glucose at four points: before the anesthesia; just after the intubations and incision; at the time of suture. Results The level of cortisol in group Ⅰ of each point were higher than the normal; The level of cortisol in group Ⅱ at the time of intubations were higher than the normal; The level of cortisol in group Ⅲ were in normal at each point. The cortisol of group Ⅱ and Ⅲ were degressive with the time. The level of cortisol in all the patients recovered in the first morning of post-operation. In group Ⅰ, the level of blood glucose increased at the times of intubations, and glucose-tolerance-test shows abnormal. There were no significant blood glucose changes in other groups. Conclusion Etomidate could control the stress response to the surgery better during the anesthesia. There was no significant effect on the neuroendocrine stress response to the patients whose neuroendocrine were normal before the operation.

　　【Key words】 anesthesia; etomidate; drug delivery system; stress response

　　围麻醉期应激反应可改变机体的`内分泌、代谢及免疫功能,影响外科疾病的转归和患者的预后。如何调控围麻醉期应激反应的程度,已成为人们关注的热点,目前尚无理想的处理措施。依托咪酯乳剂自临床应用以来，它起效时间迅速，作用时间短，麻醉效能强，对心血管干扰轻，在麻醉诱导中的应用一直得到麻醉医师的认可［1］。有报道其对肾上腺皮质功能有一定抑制作用［2］，因而较少在麻醉维持 中应用。本研究利用依托咪酯这一特性，应用靶控输注技术以试图减轻患者围术期的应激反应，现总结如下。

　　1 资料与方法

　　1.1 一般资料 择期手术需插管全麻的患者，术前访视ASA在Ⅰ～Ⅱ级，排外肝肾功能障碍，无内分泌疾病史及家族史，术前空腹血糖6.0mmol/L以下，近期内未服用任何 含激素类药物，即进入研究对象组。包括患者45例，男17例，女28例，年龄19～56岁。其中，妇科手术10例，胃肠外科手术15例，颅脑外科5例，乳腺外科8例，骨科7例。