丙泊酚对体外循环期间患者血压及应激激素的影响.docVIP

丙泊酚对体外循环期间患者血压及应激激素的影响 　　作者：雷庆红,刘俊,张大军　　作者单位：1. 宁夏医科大学附属医院麻醉科， 银川 750004;2. 宁夏医科大学附属医院核医学科， 银川 750004 　　【摘要】目的 观察不同剂量丙泊酚对体外循环期间的应激激素的影响及对高血压的防治作用。方法 选择20例风湿性心脏瓣膜病患者，随机分为两组，体外循环期间以全凭丙泊酚[6mg/(㎏oh)]控制血压组(P)和丙泊酚[4 mg/(㎏oh)]加尼卡地平控制血压组(N)，各10例，两组体外循环前后麻醉用药相同;监测指标：分别于入室建立有创动脉压监测后(T1)、体外循环前(T2)、体外循环30min(T3)、停体外循环10min(T4)时记录各时点时的心率(HR)、收缩压(SBP)、舒张压(DBP)及平均动脉压(MAP)。同期采集动脉血2mL，检测各时点血浆去甲肾上腺素(NE) 、内皮素(ET)。结果 SBP两组 T2 、T3时显著低于T1，组间相比T3N明显低于P组;MAP两组T2、T3时显著低于T1， 组间相比T3、T4 N组明显低于P组。 两组间各时间点的NE、 ET浓度组间比较差异无统计学意义;组内比较： NE、ET水平在T3、T4时显著升高，与T1、T2相比差异有统计学意义。结论 在体外循环期间应用丙泊酚持续泵注可防止血压的升高，在4～10mg/kg范围内对应激反应无显著抑制作用。 　　【关键词】 丙泊酚;去甲肾上腺素;内皮素;体外循环 　　The Effects of Propofol on Hypertension and Stress Hormone during Cardiopulmonary Bypass　Dept. of Anesthesiology，the Affiliated Hospital of Nngxia Med. Univ.，Yinchuan 750004 　　Abstract：Objective To explore the inhibitory action of stress reaction during cardiopulmonary bypass and prevention and cure for hypertension by using different doses of propofol. Methods 20 patients with rheumatic valvular disease of the heart were randomly divided into two group( P group and N group). In P group， the mean blood pressure was controlled by propofol infusion of 4mg/kg/h and in N group the mean blood pressure was controlled by propofol and nicardipine infusion. The heart rate (HR)， systolic blood pressure (SBP)， diastolic blood pressure (DBP) and mean blood pressure (MAP) were recorded before induction (T1)， before cardiopulmonary bypass (T2)，30mins after cardiopulmonary bypass (T3) and 10mins after cardiopulmonary bypass stopping (T4). Blood samples (2mL) were taken at T1， T2，T3 and T4 for determining norepinephrineh (NE)、endothelin (ET). Results No significant difference were found in HR， SBP， DBP and MAP at T1 between two groups. There were no significant difference in NE、ET plasma concentration at T1， T2， T3 and T4 between two groups. The plasma concentration of NE at T3 and T4 were significantly higher than those at T1 and T2 (P0.05). Conc