七氟烷对维吾尔族、汉族患者腹腔镜胆囊切除术中应激反应及术后苏醒质量的影响

摘要

Objective To compare and observe the effects of sevoflurane on surgical stress and postoperative recovery quality during Uighurs and Hans. Methods 60patients undergoing laparoscopic cholecystectomy were equally divided into Uighurs and Hans (n =30 each). Two groups were induced with 8% sevoflurane, and maintained with 3% ~5% sevoflurane. Blood cortisol were measured at the time after enter the operation room, 3 min after induced, 1 min after intubation, 5 min after pneummoperitoneum, the time when gallbladder was taken out and the operation end with ELISA. The HR, MAP,RR after operation were monitered, and the VAS score, Ramsay score, adverse reaction were recorded. Results Compared with T0, the blood cortisol levels of two groups at T1 ~ T5 were significantly increased ( all P < 0. 05 ) , Hans group reached peak at T4, and Uighurs groups reached at T3; blood cortisol of Hans group were lower than the Uighurs group at T3 , T5 ( all P < 0. 05 ) . There was no significant difference in VAS, Ramsay score between the two groups ( all P >0.05). Agitation level of 0 in Hans group was 19 cases, recovery time was (6. 21 ±1.03) min, extubation time was (14. 20 ±2. 07) min; Uighurs group were 24 patients, (5.33 ±0.52) min, (12. 18 ±2.11) min, allP<0.05. Adverse reactions of two groups were 11,9. Conclusions Sevoflurane can effectively inhibit operation stress, but the effect in Hans is more obvious than Uighurs. The Uygur patients is faster in postoperative recovery, lower agitation in than Hans.%目的 对比观察七氟烷对维吾尔族、汉族腹腔镜胆囊切除术(LC)患者术中应激反应及术后苏醒质量的影响.方法 选择60例拟行LC的患者,按民族分为维吾尔族组与汉族组各30例.两组采用相同的麻醉方法,麻醉诱导吸入8％七氟烷,麻醉维持吸入3％ ～5％七氟烷.分别于入室后(T0)、麻醉诱导后3 min(T1)、插管后1 min(T2)、气腹后5 min(T3)、胆囊取出时(T4)及手术结束即刻(T5)静脉采血,用ELISA方法测定血浆皮质醇水平,观察术中应激反应；术后苏醒质量监测复苏期HR、MAP、RR,记录拔管后5、30、60 min镇痛评分(VAS)、镇静评分(Ramsay评分),观察躁动及不良反应发生情况.结果 与T0时比较,两组T1 ～ T5时血浆皮质醇水平均升高(P均＜0.05),汉族组于T4达峰值,维吾尔族组于T3达峰值；维吾尔族组T3、T5时血浆皮质醇水平均较汉族组高(P均＜0.05).两组不同时点VAS、Ramsay评分比较,P均＞0.05.汉族组复苏期躁动程度0级19例,睁眼时间(6.21±1.03)min,拔管时间(14.20±2.07)min；维吾尔族组分别为24例、(5.33 ±0.52)min、(12.18±2.11)min.两组比较,P均＜0.05.两组出现不良反应分别为11、9例,P＞0.05.结论 七氟烷能有效抑制LC手术中的应激反应,但对汉族人群的抑制效果更明显；维吾尔族患者术后苏醒较汉族患者快,且躁动发生率低.