摘要
【目的】探讨采用不同麻醉方式对腹腔镜胆囊切除术(LC)中麻醉效果的维持作用及对患者血管内皮细胞功能的影响。【方法】行LC的78例患者随机分为A组和B组,每组39例,A组采用丙泊酚复合瑞芬太尼麻醉,B组采用七氟醚麻醉。观察两组患者麻醉维持效果和血管内皮细胞功能[外周血P-选择素、细胞间黏附分子-1(ICAM-1)、血栓调节蛋白(TM)]指标的变化。【结果】A组患者的麻醉诱导时间显著高于B组(P<0.01);A组的拔管时间、苏醒时间、麻醉苏醒室停留时间显著低于B组(P<0.01);A组患者四个时间段中心动脉压(MAP)及二氧化碳分压(PaCO_(2))的波动范围小于B组(P>0.05);A组患者在气腹15 min时的MAP、PaCO_(2)显著低于B组(P<0.01);解除气腹后A组的PaCO_(2)显著低于B组(P<0.01);A组患者在气腹15 min时血浆一氧化氮(NO)含量显著低于B组(P<0.01)。同时A组患者在气腹15 min时血浆内皮素-1(ET-1)含量显著高于B组(P<0.01);A组患者的P-选择素、TM在气腹前、气腹15 min、解除气腹三个时间点均显著低于B组(P<0.01);两组患者ICAM-1水平比较差异无统计学意义(P>0.05)。【结论】采用丙泊酚复合瑞芬太尼的麻醉方式用于LC术,虽然会增加麻醉诱导时间,但是其具有更好的术中麻醉维持效果,而且有助于保持血流动力学指标的稳定性,同时在建立气腹过程中可提高血浆NO浓度,降低ET-1及血管内皮细胞功能指标P-选择素、ICAM-1水平,有助于改善患者的血管内皮细胞功能。
【Objective】To observe the effect of different anesthesia methods on the maintenance of anesthesia and vascular endothelial function during laparoscopic cholecystectomy(LC).【Methods】A total of 78 patients who underwent LC in our hospital were divided into A Group(n=39)and B Group(n=39)by random number table.A group was anesthetized with propofol combined with remifentanil,and B group was anesthetized with sevoflurane.Anesthesia effects(induction time,extubation time,anesthesia recovery time)and vascular endothelial cell function such as peripheral blood P-selectin,intercellular adhesion molecule-1(ICAM-1)and thrombomodulin(TM)were recorded and compared between the two groups.【Results】The anesthesia induction time in A group were significantly higher than B group(P<0.01),while the extubation time,recovery time,and anesthesia recovery room stay time of A group were significantly lower than those of B group(P<0.01).The fluctuation range of blood pressure(MAP)and partial pressure of carbon dioxide(PaCO_(2))at 4 time points was smaller than B group(P>0.05).Levels of MAP and PaCO_(2) of patients in A group at 15 minutes of pneumoperitoneum were significantly lower than those in B group(P<0.01).After pneumoperitoneum,the PaCO_(2) of A group was significantly lower than B group(P<0.01).The plasma nitric oxide(NO)content of patients in A group was significantly lower than that in B group at 15 minutes of pneumoperitoneum(P<0.01),while at the same time plasma endothelin-1(ET-1)content in group A was significantly higher than that in B group(P<0.01).P-selectin and TM in group A were significantly lower than those in B group at four times before pneumoperitoneum,at 15min of pneumoperitoneum and post-pneumoperitoneum,and the differences were statistically significant(P<0.01).There was no significant difference in ICAM-1 between two groups(P>0.05).【Conclusion】The use of propofol combined with remifentanil for LC surgery will increase the induction time of anesthesia,while it had better intraoperative anesthesia effect to maintain the stability of hemodynamic indicators.At the same time,during the establishment of pneumoperitoneum,plasma NO concentration was increased,ET-1 level was decreased,and vascular endothelial cell function indicators P-selectin and blood ICAM-1 were decreased,which suggested LC had improved vascular endothelial cell function in patients.
作者
张静贻
韦宁华
ZHANG Jing-yi;WEI Ning-hua(Department of Anesthesiology,The Second Affiliated Hospital of Xi'an Medical College,Shaanxi Xi'an 710038)
出处
《医学临床研究》
CAS
2022年第2期194-197,共4页
Journal of Clinical Research
基金
陕西省科学技术厅项目(编号:2016SF-166)。
