您当前的位置:首页 > 主题内容 > 临床麻醉 > 基础与临床研究

硬膜外阻滞及不同全麻诱导药物对血浆血栓素B<sub>2</sub>和6-酮-前列腺素F<sub>1α</sub>的影响

时间:2010-08-24 11:36:01  来源:  作者:

<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /> 

THE INFLUENCE OF EPIDURAL ANESTHESIA AND DIFFERENT GENERAL ANESTHETIC AGENT ON THROMBOXANE B2 AND 6ketoPROSTAGLANDIN F1α

 

刘慧贞 李刚 许永广

山东省立医院麻醉科

L IU HuizhenL I GangXU Yongguang

Dept. of AnesthesiaShandong Provincial Hospital

 

ABSTRACT

  ObjectiveTo observe the influence of epidural anesthesia and different general aneshthetic agent on plasma thromboxane B2 TXB2and 6ketoprostaglandin F1α6ketoPGF1αconcent ration before and during surgery.

  Methods42 patient s undergoing elective abdominal surgery were allocated randomly in three groupsepidural anesthesiagroup1n14),general anesthesia induced with thiopentalgroup2n14),general nesthesia induced with propofol and midazolamgroup3n14.Every group was also allocated randomly in group An7and group Bn7. Venous blood samples were collected at two timebefore anesthesia and 1520 minute after anesthesia group A were before skin incisiongroup B were 510 minute after skin incision.

<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /> 

  ResultsIn group 2plasma TXB2 concent ration significantly increased f rom 179.8±44.0pg. Ml1 to268.7±92.9pg. Ml1 after skin incision P<0.05. PlasmaTXB2 after skin incison was also significant higher than before skin incisonP<0.05. In group 3plasma thromboxane B2 TXB2 concent ration significantly decreased f rom168.4±79.7 pg. Ml1 to 108.8±43.9pg. Ml1 after anesthesia P<0.05),plasma TXB2 level before skin incison were lower than after skin incisonP<0.05. After skin incisonTXB2 was higher in group 2 than in group 3P<0.05.

  ConclusionPlasma TXB2 concent ration is increased during surgical st ress which is inhibited by epidural anesthesia in some degree. Propofol and midazolam siginficantly decreases TXB2 level.

  KEY WORDSAnesthesiaepiduralAnesthesiageneralProstaglandingsFThromboxana B2.

 

  探讨硬膜外阻滞及不同全麻诱导药物对手术患者血浆TXA2PGI2的影响,从而为选择麻醉方法及全麻诱导药物提供依据。

 

资料与方法

  1.1. 资料  腹部手术患者42例,2968岁,4491kgASA分级13级,无内分泌、血液及心血管系统合并症,术前无大出血,未用过影响血小板功能的药物。42例随机分为3组:硬膜外麻醉组(1组)14例,以硫喷妥钠诱导全麻组(2组)14例,以异丙酚加咪唑安定诱导全麻组(3组)14例。每组又随机分为AB两个小组,各7例,A组为手术切皮前,B组为切皮510min。试剂盒由北京北方生物技术研究所(苏州医学院监制)提供。

  1.2. 麻醉方法及采样  术前常规应用鲁米那钠、阿托品。诱导方法:1组选择中下胸段椎间隙(胸812)穿刺置管,试验量为2%利多卡因5ml,首次量分次或单次注入0.75%布比卡因10ml2组以硫喷妥钠57mg kg1、玻珀胆碱1.52mg kg1、卡肌宁0.6mg kg1、芬太尼810μg kg1静脉诱导后气管插管;3组以异丙酚11.5mg kg1、咪唑安定0.10.15mg kg1取代2组硫喷妥钠,余同2组。采样:麻醉诱导前静脉采第1个血样,诱导后1520minA组为手术切皮前,B组为切皮510min)采第2个血样。血浆血栓素B2TXB2)及-酮-前列腺素F1α6ketoPGF1α)以放免法测定。

<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /> 

  1.3. 统计学分析  各结果以x±s表示。组内自身前后比较用配对t检验;组间差异用两样本均数比较的t检验;方差不齐时间用t′检验。P<0.05为差异显著。

 

结  果

  2.1. 各组患者年龄、体重、性别比及手术种类  见表1

  2.2. 各组病人血浆TXB26ketoPGF1α及T/K水平  见表2

 

讨  论

  血栓素A2TXA2)与前列腺环素(PGI2)为花生四烯酸代谢产物。正常情况下,TXA2PGI2保持平衡。两者均不稳定,迅速变为血栓素B2TXB2)和6-酮-前列腺素F16ketoPGF1α)。TXB2主要来源于血小板[1],手术过程中应激激素升高,血小板被激活[23]。本研究显示,以硫喷妥钠诱导全麻组手术切皮后血浆TXB2浓度较诱导前显著升高,两种全麻诱导方法诱导后同一时点血浆TXB2浓度切皮组较未切皮组也明显增高,说明手术应激对TXB2浓度的影响。

  麻醉方法本身对血小板活性并无影响。手术中TXB2浓度的改变是由手术应激造成的,这种应激反应能被大剂量的麻醉性镇痛药减弱;硬膜外麻醉阻滞了交感神经,减少了手术创伤传入神经节的传入信号,消除了神经内分泌反应,能显著抑制应激激素的升高[23],可见麻醉方法对其影响是通过调控应激程度实现的。切皮后比较,硬膜外麻醉组TXB2浓度虽然偏低,但无统计学意义(0.05<P<0.1),分析原因,一方面由于硬膜外阻滞并不能完全消除神经内分泌反应;另一方面与全麻诱导应用大剂量芬太尼抑制手术应激有关。

  麻醉药物也在不同环节影响TXB2的合成。异丙酚可以降低血小板内Ca2+浓度从而抑制血小板功能[4],使血浆TXB2浓度降低,咪唑安定结构有咪唑环,能抑制血栓素合成酶的活性,因此直接抑制血小板TXB2的合成。异丙酚加咪唑安定组诱导后TXB2明显下降;诱导后及切皮后血浆TXB2浓度均低于硫喷妥钠组的对应时点,也表明异丙酚及咪唑安定对TXB2的产生有抑制作用,而这一抑制作用在术中恰好“抵消”了应激过程对血小板的激活。

  因此硬膜外麻醉和异丙酚加咪唑安定诱导在术中能使血浆TXB2浓度及T/K比值保持稳定,对有缺血性心脏病及行外周血管手术的病人是有利的。

 

参考文献

1. 李永荣,姚德厚,郭贵林.吸入麻醉药对人血浆和血小板血栓素B2生成与血小板聚集的影响[J].中华麻醉学杂志,1997172):77.

2. Thwaites BKNigus DBBouska GWet al. Intravanous Ketorolac Tromethemine worsens platelet function during knee arthroscopy under spinal anesthesia[J]. Anesth Analg1996821176.

3. Thwaites BKNigus DBBouska GWet al. Intravenous Ketorolac Tromthemine dose not worsen platelet function during knee arthroscopy under general anesthesia[J]. Anesth Analg199581119.

4. Aoki HMizobe TNozuchi Set al. In vivo and in vitro studies of the inhibitory effect of propofol on human platelet aggregation[J]. Anesthesiology199881362.

来顶一下
返回首页
返回首页

本周热点文章

站内搜索: 高级搜索
关于我们 | 主编信箱 | 广告查询 | 联系我们 | 网站地图 |