摘要
目的 探讨单肺通气期间不同麻醉深度对胸腔镜下肺叶切除患者应激反应的影响。方法 选取山西医科大学第二医院2018年9月至2019年5月行胸腔镜肺叶切除手术的患者60例,按照随机数字表法分为三组,每组20例;A组维持深度麻醉,即脑电双频指数(BIS)为36~45,B组维持中度麻醉,即BIS为46~55,C组未行BIS监测。比较三组患者麻醉诱导前(T0)、单肺通气即刻(T1)、单肺通气60 min(T2)、缝皮结束即刻(T3)的心率、平均动脉压(MAP)、应激指标皮质醇及血糖的变化情况。结果 T1、T2、T3时刻A组的血糖浓度分别为(5.28±0.49)mmol/L、(5.34±0.49)mmol/L、(5.40±0.47)mmol/L,皮质醇浓度分别为(142.75±31.45)ng/ml、(181.36±19.62)ng/ml、(153.81±33.92)ng/ml;B组的血糖浓度分别为(5.63±0.35)mmol/L、(6.06±0.19)mmol/L、(5.79±0.44)mmol/L,皮质醇浓度分别为(168.45±31.16)ng/ml、(171.09±25.28)ng/ml、(159.39±18.77)ng/ml;C组的血糖浓度分别为(6.35±0.56)mmol/L、(7.04±0.26)mmol/L、(6.17±0.54)mmol/L,皮质醇浓度分别为(191.13±46.00)ng/ml、(283.25±30.07)ng/ml、(183.01±19.71)ng/ml。C组T1、T2、T3时刻的血糖及皮质醇浓度均较A、B组高,差异均有统计学意义(均P<0.05);A组与B组T1时刻的皮质醇差异有统计学意义(P<0.05)。A组T1、T2、T3时刻的MAP分别为(69±5)mmHg(1 mmHg=0.133 kPa)、(67±6)mmHg、(75±7)mmHg,B组分别为(80±8)mmHg、(79±4)mmHg、(84±9)mmHg,两组差异均有统计学意义(均P<0.05)。A、C组T1、T2、T3时刻的心率、MAP与各自T0时刻间差异均有统计学意义(均P<0.05);B组T1、T2时刻的心率、MAP与T0时刻差异均有统计学意义(均P<0.05)。结论 胸科手术单肺通气期间应行BIS麻醉深度监测,并使之维持于46~55,这不仅可抑制应激反应而且对血流动力学影响较轻微。
Objective To study the effects of different anesthesia depths on stress response during single-lung ventilation in patients with thoracoscopic lobectomy.Methods Sixty patients selected for elective thoracoscopic lobectomy in the Second Hospital of Shanxi Medical University from September 2018 to May 2019 were randomly divided into three groups according to the digital random table method,with 20 patients in each group.Group A maintained deep anesthesia with the bispectral index(BIS)36-45,group B maintained moderate anesthesia with BIS 46-55,and group C did not undergo BIS monitoring.The changes of heart rate,mean arterial pressure(MAP),stress indexes cortisol and blood glucose before anesthesia induction(T0),immediately after one-lung ventilation(T1),60 min after one-lung ventilation(T2)and immediately after skin suture(T3)in the three groups were compared.Results The concentration of blood glucose in group A at T1,T2 and T3 was(5.28±0.49)mmol/L,(5.34±0.49)mmol/L and(5.40±0.47)mmol/L,and the cortisol was(142.75±31.45)ng/ml,(181.36±19.62)ng/ml and(153.81±33.92)ng/ml;the blood glucose in group B was(5.63±0.35)mmol/L,(6.06±0.19)mmol/L and(5.79±0.44)mmol/L,and the cortisol was(168.45±31.16)ng/ml,(171.09±25.28)ng/ml and(159.39±18.77)ng/ml;the blood glucose in group C was(6.35±0.56)mmol/L,(7.04±0.26)mmol/L and(6.17±0.54)mmol/L,and the cortisol was(191.13±46.00)ng/ml,(283.25±30.07)ng/ml and(183.01±19.71)ng/ml,respectively.The blood glucose and cortisol levels in group C at T1,T2 and T3 were higher than those in group A and group B(all P<0.05).The MAP in group A at T1,T2 and T3 were(69±5)mmHg(1 mmHg=0.133 kPa),(67±6)mmHg and(75±7)mmHg,respectively,and group B was(80±8)mmHg,(79±4)mmHg and(84±9)mmHg,the differences between the two groups were statistically significant(all P<0.05).There was significant difference in cortisol between group A and group B at T1(P<0.05).The heart rate and MAP at T1,T2 and T3 in group A and group C were significantly different from those at T0(all P<0.05).The heart rate a
作者
王晓玉
邢涛涛
韩郭杰
刘毅
安晓丽
Wang Xiaoyu;Xing Taotao;Han Guojie;Liu Yi;An Xiaoli(Department of Anesthesiology,Shanxi Medical University,Taiyuan 030001,China;Department of Anesthesiology,Shanxi Provincial Cancer Hospital,Taiyuan 030013,China;Department of Anesthesiology,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)
出处
《肿瘤研究与临床》
CAS
2020年第1期11-15,共5页
Cancer Research and Clinic
关键词
外科手术
监测
手术中
应激
麻醉深度
双频指数监测
Surgical procedures
operative
Monitoriry
intraoperative
Stress
Depth of anesthesia
Bispectral index monitoring
