七氟醚预防垂体后叶素诱发心血管 不良反应的效果研究

Effect of Sevoflurane on vasopressin-induced cardiovascular adverse reactions

摘要:

目的 探讨七氟醚预防垂体后叶素诱发心血管不良反应的效果。方法 选取该院2017 年1 月- 2017 年5 月收治的子宫平滑肌瘤患者60 例，使用随机数字表法分为七氟醚组和全凭静脉麻醉（TIVA）组， 每组30 例。两组患者行腹腔镜下肌瘤剔除术，七氟醚组吸入七氟醚并用瑞芬太尼静脉泵入维持；TIVA 组以 异丙酚和瑞芬太尼静脉泵入维持，记录两组患者子宫肌内注射垂体后叶素前（T0），以及注射后0.5（T1）、1.0 （T2）、2.0（T3）、3.0（T4）、5.0（T5）、10.0（T6）、20.0（T7）和30.0 min（T8）的心率（HR）、收缩压（SBP）、 舒张压（DBP）、血氧饱和度、呼气末二氧化碳、皮质醇水平；比较两组患者苏醒时间和出血量。结果 七 氟醚组患者T1 时的HR 高于T0（P <0.05）。TIVA 组患者T5、T6、T7、T8 时的HR 低于T0（P <0.05），SBP、 DBP 高于T0（P <0.05）。七氟醚组T8 时的HR 低于T0（P <0.05），但高于TIVA 组（P <0.05）。七氟醚组T1 时的SBP、DBP 低于T0（P <0.05），T7、T8 时的SBP、DBP 高于T0（P <0.05）。七氟醚组T8 时的SBP、DBP 低于TIVA 组（P <0.05）。两组患者T3、T4、T5、T6、T7、T8 时的皮质醇水平高于T0（P <0.05）。七氟醚组 T5、T6、T7、T8 时的皮质醇水平低于TIVA 组（P <0.05）。七氟醚组患者苏醒时间短于TIVA 组（P <0.05）。 七氟醚组患者出血量少于TIVA 组（P <0.05）。结论 七氟醚能有效预防垂体后叶素诱发的心血管不良反应。 与TIVA 比较，七氟醚能减小血压升高幅度，减轻应激反应，缩短苏醒时间，减少出血量，值得临床推广应用。

Abstract:

Objective To investigate the effect of Sevoflurane in preventing vasopressin-induced cardiovascular adverse reactions. Methods Sixty patients with uterine leiomyoma admitted in our hospital from January 2017 to May 2017 were randomly divided into a Sevoflurane group and a total intravenous anesthesia (TIVA) group, with 30 cases in each group. The two groups of patients underwent laparoscopic myomectomy; the patients in the Sevoflurane group had Sevoflurane inhalation and Remifentanil intravenous maintenance, the patients in the TIVA group received intravenous anesthesia with Propofol and Remifentanil intravenous maintenance. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), oxygen saturation, end-tidal carbon dioxide and cortisol level were measured in both groups before pituitrin injection into uterine muscle (T0), and 0.5 (T1), 1 (T2), 2 (T3), 3 (T4), 5 (T5), 10 (T6), 20 (T7) and 30 min (T8) after pituitrin injection. The recovery time and blood loss were compared between the two groups. Results In the Sevoflurane group HR at T1 was higher than that at T0 (P < 0.05). In the TIVA group HR at T5-T8 was lower than that at T0 (P < 0.05), while SBP and DBP at T5-T8 were higher than those at T0 (P < 0.05). HR of the Sevoflurane group at T8 was lower than that at T0 (P < 0.05) but higher than that of the TIVA group (P < 0.05). In the Sevoflurane group, SBP and DBP at T1 were lower than those at T0 (P < 0.05), while SBP and DBP at T7 and T8 were higher than those at T0 (P < 0.05). At T8, SBP and DBP in the Sevoflurane group were lower than those in the TIVA group (P < 0.05). In both groups the cortisol level at T3-T8 was higher than that T0. The serum cortisol level at T5-T8 in the Sevoflurane group was lower than that in the TIVA group (P < 0.05). The recovery time of the patients in the Sevoflurane group was significantly shorter than that in the TIVA group (P < 0.05). The amount of bleeding in the Sevoflurane group was significantly less than that in the TIVA group (P < 0.05). Conclusions Sevoflurane can effectively prevent vasopressin-induced cardiovascular adverse reactions. Compared with total intravenous anesthesia, Sevoflurane can significantly reduce the rise of blood pressure, reduce stress response, shorten the recovery time, and reduce the amount of bleeding, therefore it is worth clinical promotion.