摘要
目的探讨七氟醚和硝普钠（SNP）控制性降压对患者一氧化氮（NO）、内皮素（ET）和氧自由基的影响。方法择期手术病人48例，年龄28～64岁，ASAⅠ或Ⅱ级，随机分为3组（n=16）：七氟醚常压组（Ⅰ组）、七氟醚降压组（Ⅱ组）和SNP降压组（Ⅲ组）。3组麻醉诱导后均吸人七氟醚1MAC。手术开始后10min，Ⅱ组吸入七氟醚浓度增加至3MAC，Ⅲ组开始持续静脉输注0．01％SNP2～5μg·kg^-1·min^-1，使平均动脉压（MAP）快速降至基础值的60％～70％（55～73mm Hg），再调整七氟醚呼气末浓度（1．87～2．54MAC）和SNP输注速率（1．5～4μg·kg^-1·min^-1）维持降压，降压40min后，Ⅱ组七氟醚呼气末浓度降至0．8MAC；Ⅲ组停止输注SNP，使血压很快升至降压前水平。分别于手术开始后10min（降压前即刻，T0）、降压20min（T1）、40min（T2）和停止降压后20min（T3）采集静脉血，测定血浆NO、ET、丙二醛（MDA）浓度及超氧化物歧化酶（SOD）活性。结果与R比较，Ⅰ组和Ⅱ组血浆NO浓度在T1～3时降低，Ⅲ组血浆NO浓度在T1,2时升高，Ⅲ组在T1,2时血浆ET浓度升高，3组在T1～3时血浆MDA和SOD浓度均升高（P〈0．05或0．01）；与Ⅰ组比较，Ⅱ组在T1,2时血浆NO浓度降低，Ⅲ组在T1～3，时血浆NO浓度升高，Ⅲ组血浆ET浓度在T1～3时升高（P〈0．05），Ⅱ组各时点血浆NO浓度差异无统计学意义（P〉0．05）；Ⅱ组在T1～3，时血浆MDA和SOD水平升高（P〈0．05）。结论七氟醚控制性降压可降低患者血浆NO浓度，SNP控制性降压可升高血浆NO及ET浓度；七氟醚控制性降压及硝普钠控制性降压均可导致患者氧自由基生成增加，七氟醚控制性降压使氧自由基增加的程度更高。
Objective To investigate the effects of sevoflurane and sodium nitroprusside （SNP）-induced hypotension on plasma nitric oxide （NO）, endothelin （ET） and oxygen free radicals in patients undergoing elective surgery under general anesthesia. Methods Forty-eight ASA Ⅰ or Ⅱ patients aged 28-64 yr weighing 49-84 kg undergoing elective surgery under general anesthesia were randomly divided into 3 groups （ n = 16 each） ： Ⅰ control group; Ⅱ sevoflurane-induced hypotension group and Ⅲ SNP-induced hypotension group. The patients were premedicated with intramuscular phenobarbital and intravenous atropine 0.5 mg. Anesthesia was induced with propofol 2.0-2.5 mg/kg and fentanyl 4 μg/kg. Tracheal intubation was facilitated with succinylcholine 1.5-2.0 mg/ kg. Anesthesia was maintained with sevoflurane inhalation and Ⅳ pancuronium infusion. The patients were mechanically ventilated and PETCO2 was maintained at 35-45 mm Hg. Starting from 10 min after skin incision MAP was reduced to 60%-70% of baseline by inhalation of sevoflurane （in group Ⅱ ） or infusion of 0.01% SNP （in group Ⅲ ） and hypotension was maintained for 40 min. Blood samples were obtained immediately before （T0, baseline） and at 20 and 40 rain （T1 , T2 ） of and 20 rain after hypotension （T3 ） for determination of plasma NO, ET and MDA concentration and SOD activity. Results Plasma NO concentration was significandy decreased during and after induced hypotension （ T1～3 ） as compared to the baseline at To in group Ⅰ and Ⅱ but increased at T1 and T2 in group Ⅲ . Plasma ET concentration was significantly increased at T1 and T2 as compared to the baseline at To in groupm and was significantly higher at T1～3 in group m than in group Ⅰ and Ⅱ . Plasma MDA concentration and SOD activity were significantly increased at T1～3 as compared with the baseline at To in all 3 groups and were significantly higher in gro. up Ⅱ than in group Ⅰand Ⅲ. conclusion Sevoflurane-induced hypotension can decrease plasma NO concentration while SNP-induced hypotension can increase plasma NO and ET concentrations. Both sevoflurane- and SNP-induced hypotension can increase free radicals and the degree of increase is higher in sevoflurane -induced hypotension.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2007年第8期681-684,共4页
Chinese Journal of Anesthesiology
关键词
硝普钠
降压
控制性
一氧化氮
内皮缩血管肽类
活性氧
七氟醚
Nitroprusside
Hypotension, induced
Nitric oxide
Endothelins
Reactive oxygen species
Sevoflurane
