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发行周期:
月刊
主管单位:
上海市卫生健康委员会
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上海市医学会
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CN31-1366/R
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术中持续输注艾司洛尔在妇科腹腔镜手术病人中的应用

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DOI:
作者:
刘志强
zhiqiang liu
作者单位:
上海市第一妇婴保健院
Shanghai First Maternity and Infant Health Hospital
关键词:
艾司洛尔；妇科外科手术；腹腔镜；应激；血流动力学
Esmolol; Gynecological Surgery; Laparoscopy; Stress; Hemodynamics
摘要:
【摘要】 目的 探讨在妇科腹腔镜术中持续输注艾司洛尔改善患者应激反应和稳定血流动力学的疗效。方法 气管插管全麻下行妇科腹腔镜手术患者60例，随机分为三组，每组20例：Ⅰ组术中避免使用血管活性药物，常规输液至手术结束；Ⅱ组、Ⅲ组在麻醉诱导时同时予艾司洛尔0.3mg/kg静注，后分别予50ug/kg/min（Ⅱ组）或100ug/kg/min（Ⅲ组）的速率持续输注，直至手术结束。三组麻醉维持均采用舒芬太尼和丙泊酚持续静注。测定并记录麻醉诱导前（T0）、气管插管即刻（T1）、气腹后15min（T2）和手术结束时（T3）的平均动脉压（MAP）和心率（HR），及血浆去甲肾上腺素(NE)、肾上腺素(E)、皮质醇和血糖浓度。 结果 与麻醉诱导前相比，Ⅰ组患者在气管插管后血压、心率、去甲肾上腺素、肾上腺素均明显升高(P <0.05),Ⅱ组、Ⅲ组则表现为血压及心率下降，其中Ⅲ组较Ⅱ组下降更为明显(P <0.05)。除Ⅲ组的去甲肾上腺素、肾上腺素在手术结束时较诱导前有所下降外，Ⅱ组、Ⅲ组的去甲肾上腺素、肾上腺素在术中的变化无统计学意义。三组血浆皮质醇在气腹后均升高，其中Ⅰ组高于Ⅱ组和Ⅲ组 (P <0.05)。三组血糖在气管插管后均高于诱导前(P <0.05)，组间无差异。结论 术中持续输注艾司洛尔可有效改善妇科腔镜术中应激反应；与较大的输注速率（100ug/kg/min）相比,采用较小的输注速率（50ug/kg/min）在血流动力学稳定方面更佳。
【Abstract】 Objective To observe the effect of continuous infusion of esmolel to ameliorate stress reaction and stabilize hemodynamics in patients undergone gynecological laparoscopic surgery. Methods 60 Patients scheduled for gynecological laparoscopic surgery under general anesthesia with tracheal intubation were randomly divided into three groups (n=20 each): groupⅠ, saline was infused commonly till the end of operation, avoiding administrating any vasoactive drugs; group Ⅱand Ⅲ, 0.3 mg/kg of esmolol were intravenous injected before anesthesia induction and then given continuous infusion at the different rate of 50 ug/kg/min(group Ⅱ) or 100 ug/kg/min(group Ⅲ) till the end of operation. Sufentanil and propofol were used for maintenance of anesthesia. At time points of pre-induction, intubation, 15 min after pneumoperitoneum and the end of operation, mean arterial pressure (MAP) ,heart rate (HR) were measured and recorded, and serum norepinephrine(NE),epinephrine(E), cortisol(Cor), glucose(Glu) were detected as well. Results Compared to pre-induction, the values of MAP, HR and serum norepinephrine, epinephrine in groupⅠincreased significantly after the intubation (P <0.05). MAP, HR in group Ⅱand Ⅲ decreased significantly ,moreover, the values in group Ⅲ were lower than in group Ⅱ;serum norepinephrine, epinephrine in both group Ⅱand Ⅲ were nearly no differences during the operation except at the end of the operation in group Ⅲ (lower than pre-induction). Cortisol in all groups increased after pneumoperitoneum, groupⅠwas higher than group Ⅱand Ⅲ. Glucose increased significantly after intubation in group Ⅰ, Ⅱand Ⅲ,but there is no statistical difference among three groups. Conclusion Continuous infusion of Esmolel in patients undergone gynecological laparoscopic surgery can ameliorate stress reaction effectively during the operation. Compared to the high infusion rate(100 ug/kg/min),administration of infusion rate(50 ug/kg/min) may be better on the stabilization of hemodynamics.

 

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