Azemati S, Savai M, Khosravi M B, Allahyari E, Jahanmiri F
Shiraz Anesthesiology and Critical Care Research Center, Department of Anesthesiology, Shiraz University of Medical Sciences, Shiraz, Iran.
Acta Anaesthesiol Belg. 2013;64(1):25-31.
Hormonal and metabolic changes following surgery are markers of the stress response to surgery. We compared hemodynamic parameters and stress response markers (glucose, cortisol, and C-reactive protein) in two groups of patients receiving either propofol or isoflurane combined with remifentanil for maintenance of anesthesia.
We randomly assigned 100 women (ASA I-II) scheduled for diagnostic gynecologic laparoscopy to receive either isoflurane (0.8% end-tidal) or propofol (100 mg/kg/min) in addition to remifentanil (0.25 mg/ kg/min). Heart rate and mean arterial pressure were recorded after induction, 30 seconds after intubation, at four time points after incision, and 60 min after surgery. Serum C-reactive protein, cortisol and glucose concentrations were measured before induction, one hour after incision, and one hour after surgery.
After induction, heart rate decreased significantly from baseline in both groups, and remained below baseline until the end of surgery. Mean arterial pressure also decreased significantly in both groups. C-reactive protein levels were not significantly different between groups. In the propofol group, cortisol decreased significantly one hour after incision, but increased in the isoflurane group. Glucose increased significantly in both groups, but was significantly lower in the propofol group one hour after the incision and one hour after surgery.
An anesthetic regimen combining propofol and remifentanil attenuates two indicators of the stress response more efficiently than a isoflurane - remifentanil combination.
手术后的激素和代谢变化是手术应激反应的标志物。我们比较了两组接受丙泊酚或异氟烷联合瑞芬太尼维持麻醉的患者的血流动力学参数和应激反应标志物（葡萄糖、皮质醇和C反应蛋白）。
我们将100例计划进行诊断性妇科腹腔镜检查的女性患者（ASA I-II级）随机分为两组，除瑞芬太尼（0.25mg/kg/min）外，分别接受异氟烷（呼气末浓度0.8%）或丙泊酚（100mg/kg/min）。记录诱导后、插管后30秒、切口后四个时间点以及手术后60分钟的心率和平均动脉压。在诱导前、切口后1小时和手术后1小时测量血清C反应蛋白、皮质醇和葡萄糖浓度。
诱导后，两组心率均较基线显著下降，并在手术结束前一直低于基线。两组平均动脉压也显著下降。两组间C反应蛋白水平无显著差异。丙泊酚组皮质醇在切口后1小时显著下降，而异氟烷组则升高。两组葡萄糖均显著升高，但丙泊酚组在切口后1小时和手术后1小时显著低于异氟烷组。
丙泊酚与瑞芬太尼联合的麻醉方案比异氟烷-瑞芬太尼联合方案更有效地减轻了应激反应的两个指标。
