摘要
目的观察高乌甲素（lappaconitine，LA）对手术创伤病人应激水平的影响，探讨其调控应激反应的可能机制。方法选择乳腺癌根治术、椎管狭窄减压术、股骨头坏死人工头置换术患者，共36例，按病种对等随机分3组，高乌甲素组（L）、曲马多组（T）、空白对照组（B），每组12例。常规全凭静脉麻醉下实施手术，在L组、T组诱导前30min分别静脉滴注LA8mg、曲马多100mg，30min滴注完。诱导后即开始在L组、T组连接电子输注泵，以LA0．28mg／ml或曲马多8mg／ml进行持续背景输注，术后清醒后再实施PCA。B组术后按需肌肉注射哌替啶（50mg／次）和氟哌利多（2．5mg／次）镇痛。分别于麻醉用药前30min、术毕即刻、术后24h、术后48h采取外周静脉血，用放免法分别测定血浆内β-EP、ACTH、ALD水平，另份血样送检测血糖、白细胞分类计数及凝血四项（APTT、TT、PT、FIB）。结果T组在术毕即刻、术后24h，以及B组在术后各时点血浆β-EP升高与L组比较均有统计学差异（P〈0．05或P〈0．01）；T组、B组在术后各时点血浆ACTH水平升高与L组比较均有统计学差异（P〈0．05或P〈0．01）；T组在术毕即刻、B组在术后各时点血浆ALD水平升高与L组比较均有统计差异（P〈0．05）。B组在术毕即刻、术后24h血糖升高与L组比较差异有统计学意义（P〈0．05）。T组、B组在术后24h、术后48h体温较基础值升高（1．03±0．06）℃；B组中性粒细胞分类比率在术后48h升高与基础值及L组比较有统计学差异（P〈0．05）；T组在术后48h，B组在术后24h、术后48h单核细胞分类比率升高与基础值和L组比较有统计学差异（P〈0．05）：T组、B组在术后24h、术后48hAPTT缩短、B组在术后48hFIB增加与L组比较均有统计学差异（P〈0．05）。结论LA可以部分抑制手术创伤病人应激水平的增高，其机制可能与LA多种药理作用有关。
Objective To investigate the effects of lappaconitine on stress response surgical invasion, and to explore the possible mechanisms of its controlling surgical stress response. Methods 36 patients undergoing modified radical mastectomy, laminectomy or artificial femoral head replacement were randomly divided into 3 groups （n = 12）. Lappaconitine （8 mg, group L） or ramadol （100 mg, group T） was infused intravenously within 30 min before TIVA was conducted, and lappaconitine with a speed of 0.28 mg/ml （group L） or tramadol with a speed of 8 mg/ml （group T） was continuously infused after anesthesia induction. PCA started when patients woke up from anesthesia after operation. As blank control, 12 patients （group B ） did not receive either lappaconitine and lappaconitine during operation or PCA after surgery, but received pethidine （50 mg each time） and droperidol （2.5 mg each time） intramuscularly after operation as patients needed. Blood samples were collected at time-points of 30 min before anesthesia, immediate end of surgery, 24 h and 48 h after operation for detection of β-EP, ACTH, ALD, blood glucose level, leucocytes count and for blood coagulation test （ AFIT, TT, PT and FIB）. Body temperature was also monitored at the same time-points. Results Significant increase of plasma β-EP level was detected at postoprative 24 h and 48 h in group T and at all the postoperative time-points in group B, and plasma ACTH increases at each postoperative time-point in both group B and group T （compared with that in group L, P 〈0.05 - 0.01 ）. Plasma level of ALD increased significantly at the end of operation in group T and at all the postoperative time-points in group B （ compared with that in group L, P 〈 0.05 ）. Blood sugar level was higher at the end of operation and postoperative 24 h in group B than that in group L （P 〈 0.05 ）. Body temperature rose with an extent of （ 1.03± 0.06） ℃ at postoperative 24 h and 48 h in both group B and group T, but did not significantly change during peri-operation in group L. Significantly augmented ratio of neutrophll was detected at postoperavite 48 h in group B compared with its baseline and group L （P 〈 0. 05 ）. The ratio of monocyte increased markedly at postoperative 48 h in group T and at postoperative 24 h and 48 h in group B compared with their baselines and group L （ P 〈 0.05 ）. APTT became shorter at postoperative 24 h and 48 h in both group B and group T, and FIB increased at postoperative 48 h in group B compared with that in group L. conclusion The findings of present study demonstrated that LA is able to inhibit the release of stress hormones which are stimulated by surgical invasion. The mechanisms are probably related to multi-pharmacological factors.
出处
《国际麻醉学与复苏杂志》
CAS
2007年第1期10-13,共4页
International Journal of Anesthesiology and Resuscitation
