阿片受体激动药对腹腔镜手术患者血浆β内啡肽的影响(1)
【摘要】 目的 探讨芬太尼、瑞芬太尼与舒芬太尼对全麻腹腔镜手术患者血流动力学及β内啡肽的影响。方法 60例ASAⅠ~Ⅱ级择期行腹腔镜手术的患者随机分为芬太尼组(F组)、瑞芬太尼组(R组)和舒芬太尼组(S组)。术中即时记录MAP(平均动脉压)和HR(心率)的变化并于麻醉前(T1)、气腹前(T2)、气腹后30 min(T3)和解除气腹后15 min(T4)四个时点抽取静脉血测定β内啡肽的含量。结果 MAP和HR的变化：在T1、T4时相3组间比较差异无统计学意义，在T2、T3时相R组和S组较F组显著降低(P<005)，且R组和S组比较无差异。3组患者血浆β内啡肽含量的改变：与T1时相比较，3组患者血浆β内啡肽的含量均明显升高(P<005)，与F组比较，在T1、T2时相3组差异无统计学意义(P>005)，T3和T4时相R组和S组均较F组明显降低(P<005)，R组和S组比较差异无统计学意义(P>005)。结论 在全凭静脉全身麻醉下，芬太尼、瑞芬太尼和舒芬太尼均可较好的维持血流动力学的稳定，三者相比，舒芬太尼和瑞芬太尼能更有助于降低伤害性刺激，减轻应激反应。
, 百拇医药
【关键词】
腹腔镜手术；阿片受体激动药；β内啡肽
The influence of βEPin blood plasma of patients with opioid agonists during laparoscope
CHENG Xiaoyan.
Department of Anesthesia,The people’s Hospital of Weifang city in Shandong province,Weifang 261041,China
【Abstract】 Objective To investigate the influence of βEP in blood plasma of the patients with opioid agonists during laparoscope Methods Sixty ASAⅠ~Ⅱpatients undergoing the elective laparoscopic operation were randomly divided into three groups：group fentanyl (group F),group remifentanil (group R) and group sulfentanyl (group S).During the operation MAP and HR were recorded at sight The contents of βEP were measured by extracting the internal jugular vein blood on four moments：T1before the anesthesia； T2before the pneumoperitoneum,T330 minutes after the pneumoperitoneum； T415 minutes after the remove of the pneumoperitoneum Results HR and MAP showed no marked change on the T1 and T4,but on the T2 and T3 the changes were decreased compared with group F(P<005),and there were no marked change between group R and group S Compared with T1, the content of βEP was obviously increased on the T2,T3 and T4 on group F,R and S, P<005) Compared with group F, the content of βEP decreased on the T3 and T4 on group R and S, (P<005).There were no difference on the T1 and T2(P>005).Conclusion On the total general intravenous anesthesia, the opioid agonists could stable the hemodanmics To lower the nociceptive stimulus and ease the stress reaction，remifentanyl and sulfentanyl were better than fentanyl.
, 百拇医药
【Key words】
Laparoscopic operation； Opioid agonists； βEP
腹腔镜手术具有创伤小、手术时间短、术后恢复快等优点，但由于建立人工气腹时会造成腹内压增高和高碳酸血症，对机体产生强烈刺激而引发呼吸循环系统的应激反应，引起血流动力学不稳定[1]。β内啡肽(βEP)是内源性阿片样神经肽，在伤害性刺激引起的应激状态下，βEP合成和分泌增加[2]。本研究拟观察比较不同的阿片受体激动药复合丙泊酚对患者血浆βEP浓度的影响。
1 资料与方法
11 一般资料 选择60例ASAⅠ~Ⅱ级择期行腹腔镜手术的患者，年龄30~65岁，按随机双盲法分为芬太尼组(F组)、瑞芬太尼组(R组)和舒芬太尼组(S组)，每组20例。
, http://www.100md.com
12 方法 患者术前准备完善，入室后，连接多参数心电监护仪，开放静脉通路，记录入室的MAP及HR、SpO2(脉搏氧饱和度)。麻醉诱导以咪达唑仑005 mg/kg，阿片受体激动药(芬太尼组芬太尼4 μg/kg，瑞芬太尼组瑞芬太尼2 μg/kg，舒芬太尼组舒芬太尼04 μg/kg)，丙泊酚2 mg/kg和维库溴铵01 mg/kg静脉缓慢推注，气管内插管，连接麻醉机，机械通气控制呼吸，氧流量15 L/min，潮气量8~10 ml/kg，呼吸频率12次/min，吸呼比1：2，维持呼气末二氧化碳分压35~45 mm Hg。各组术中气腹压力均为12 mm Hg。麻醉维持：术中持续输注舒芬太尼018~03 μg/(kg·h)或瑞芬太尼12~30 μg/(kg·h)或芬太尼18~3 μg/(kg·h)，均复合持续输注丙泊酚4~12 mg/(kg·h)，分次静脉注射维库溴铵维持肌松。所有麻醉处理均由同一麻醉医师完成。
13 观察指标
131 血流动力学指标 记录两组患者CO2麻醉前(T1)、气腹前(T2)、气腹后30 min(T3)和解除气腹后15 min(T4)四个时点的MAP和HR。
132 βEP的测定 3组患者分别在麻醉前(T1)、气腹前(T2)、气腹后30 min(T3)和解除气腹后15 min(T4)4个时点抽取患者静脉血5 ml加入含肝素钠抗凝的试管，混匀，4 ℃ 3500 r/min离心10 min，提取血浆20℃保存。按人βEP酶联免疫吸附测定试剂盒(双抗体夹心ELISA法定量测定)说明进行操作。, 百拇医药(程晓燕)
, 百拇医药
【关键词】
腹腔镜手术；阿片受体激动药；β内啡肽
The influence of βEPin blood plasma of patients with opioid agonists during laparoscope
CHENG Xiaoyan.
Department of Anesthesia,The people’s Hospital of Weifang city in Shandong province,Weifang 261041,China
【Abstract】 Objective To investigate the influence of βEP in blood plasma of the patients with opioid agonists during laparoscope Methods Sixty ASAⅠ~Ⅱpatients undergoing the elective laparoscopic operation were randomly divided into three groups：group fentanyl (group F),group remifentanil (group R) and group sulfentanyl (group S).During the operation MAP and HR were recorded at sight The contents of βEP were measured by extracting the internal jugular vein blood on four moments：T1before the anesthesia； T2before the pneumoperitoneum,T330 minutes after the pneumoperitoneum； T415 minutes after the remove of the pneumoperitoneum Results HR and MAP showed no marked change on the T1 and T4,but on the T2 and T3 the changes were decreased compared with group F(P<005),and there were no marked change between group R and group S Compared with T1, the content of βEP was obviously increased on the T2,T3 and T4 on group F,R and S, P<005) Compared with group F, the content of βEP decreased on the T3 and T4 on group R and S, (P<005).There were no difference on the T1 and T2(P>005).Conclusion On the total general intravenous anesthesia, the opioid agonists could stable the hemodanmics To lower the nociceptive stimulus and ease the stress reaction，remifentanyl and sulfentanyl were better than fentanyl.
, 百拇医药
【Key words】
Laparoscopic operation； Opioid agonists； βEP
腹腔镜手术具有创伤小、手术时间短、术后恢复快等优点，但由于建立人工气腹时会造成腹内压增高和高碳酸血症，对机体产生强烈刺激而引发呼吸循环系统的应激反应，引起血流动力学不稳定[1]。β内啡肽(βEP)是内源性阿片样神经肽，在伤害性刺激引起的应激状态下，βEP合成和分泌增加[2]。本研究拟观察比较不同的阿片受体激动药复合丙泊酚对患者血浆βEP浓度的影响。
1 资料与方法
11 一般资料 选择60例ASAⅠ~Ⅱ级择期行腹腔镜手术的患者，年龄30~65岁，按随机双盲法分为芬太尼组(F组)、瑞芬太尼组(R组)和舒芬太尼组(S组)，每组20例。
, http://www.100md.com
12 方法 患者术前准备完善，入室后，连接多参数心电监护仪，开放静脉通路，记录入室的MAP及HR、SpO2(脉搏氧饱和度)。麻醉诱导以咪达唑仑005 mg/kg，阿片受体激动药(芬太尼组芬太尼4 μg/kg，瑞芬太尼组瑞芬太尼2 μg/kg，舒芬太尼组舒芬太尼04 μg/kg)，丙泊酚2 mg/kg和维库溴铵01 mg/kg静脉缓慢推注，气管内插管，连接麻醉机，机械通气控制呼吸，氧流量15 L/min，潮气量8~10 ml/kg，呼吸频率12次/min，吸呼比1：2，维持呼气末二氧化碳分压35~45 mm Hg。各组术中气腹压力均为12 mm Hg。麻醉维持：术中持续输注舒芬太尼018~03 μg/(kg·h)或瑞芬太尼12~30 μg/(kg·h)或芬太尼18~3 μg/(kg·h)，均复合持续输注丙泊酚4~12 mg/(kg·h)，分次静脉注射维库溴铵维持肌松。所有麻醉处理均由同一麻醉医师完成。
13 观察指标
131 血流动力学指标 记录两组患者CO2麻醉前(T1)、气腹前(T2)、气腹后30 min(T3)和解除气腹后15 min(T4)四个时点的MAP和HR。
132 βEP的测定 3组患者分别在麻醉前(T1)、气腹前(T2)、气腹后30 min(T3)和解除气腹后15 min(T4)4个时点抽取患者静脉血5 ml加入含肝素钠抗凝的试管，混匀，4 ℃ 3500 r/min离心10 min，提取血浆20℃保存。按人βEP酶联免疫吸附测定试剂盒(双抗体夹心ELISA法定量测定)说明进行操作。, 百拇医药(程晓燕)