Effect Of Propofol Or Isoflurane On Plasma Endothelin,Thromboxane And Hemodynamics In Patients With CO₂ Pneumoperitoneum

Hour of the laparoscopic cholecystectomy(LC),the pneumo-peritoneum of CO2 will bring pressure with the organ of the peritoneum empress to the inside of peritoneum , increasing because of the pressure inside the peritoneum high,the diaphragma goes on stage,making pressure inside the chest also increased obviously high,from but cause the sufferer's endocrine system been obvious to change with hemodynamics occurrence. Traditional intravenous-inhalation combined anesthesia only can depending on anestheticst according to the variety of blood pressure and heart rate to regulate the depth of anesthesia,usually exsits hystersis phenolmenon,but the target controlled infusion(TCI)to lose to note the system to the feedback with the plasma concentration or effect room concentrations calculator that control accrording to the medicine on behalf dynamoics three -compartment model. This research observes LC patients' dynamic variety of plasma endothelium(ET),thromboxane B2(TXB2)and hemodynamics in the operation,and compare the clinical anesthesia effect of between the propofol target controlled infusion intravenous anesthesia and the isoflurane inhalation anesthesia.Twenty patients(ASAⅠ-Ⅱ) undergoing elective LC were randomized to two groups:propofol group(Ⅰgroup) and isoflurane group(Ⅱgroup). Anesthetic method:The Ⅰgroup propofol target controls induction of anesthesia and keep on TCI the propofol in the operation to maintain the anesthesia,the Ⅱgroup artificial bolus propofol induction of anesthesia and keep on inhaling isoflurane in the operation to maintain the anesthesia,inhalation concentration 0.8%～2%.Monitoring sign:recorded average artery presses(MAP),heart rate(HR),hem oxygen saturation degree(SpO2)before anesthesia(T1),before pneumoperitoneum(T2),after pneumoperitoneum 3 mins(T3),after pneumoperitoneum 20 mins(T4),anesthesia ending(T5) and extubation time,adopting the venous blood to measure ET and TXB2 with the emanation immuneity method at the same time. Statistics the method:All data was expressed by( x ±s),use t-test statistical method to deal with.According to the size of P to conclude the difference:p<0.05is significant differentce.Result: Two groups ET were lower when anesthesia ended than before anesthesia but no significant change; When anesthesia ends propofol group TXB2 was increase obviously than before anesthesia, isoflurane group TXB2 was significant increase than before anesthesia; Before pneumo-peritoneum the HR and MAP was respectively significant reduce and significant lower than before anesthesia; The isoflurane group HR was quicker obviously than before anesthesia; The HR MAP fluctuation of isoflurane group was bigger in the operate; Extubation time of isoflurane group was extended obviously than propofol group. Conclusion:Anesthesia and the pain of the surgical operation, lead long to pull the stimulus wills cause the patient's endocrine system to is obvious to change with hemodynamics occurrence.The fentanyl can represss the ET secret and release,the propofol can relax the ET causes of leave the body coronary artery contrats,also can repress the signal that leave the afferent and smooth iliacus in aorta in body inside ET conduct, having theinhibition to the ET,isoflurane general anesthesia ET lowers. This research two groups'ET all have no obvious variety,hinting the target controlled infusion propofol and isoflurane inhalation anesthesia can ET effectively in restrant of surgical operation trauma stimulus cause to go up, at the same time general anesthesia small surgical operation ET has no the obvious variety. The propofol can make TXB2 lowered, this research isoflurane group TXB2 after operation was significant increase than before operation mutually for propofol group, at the same time isoflurane group HR after operation was obvious more quick than before operation mutually for propofol group, explaining isoflurane group stress reaction at extubation was more stronger than propofol group, so propofol group more steady, benefit to the patient instauration more at extubation oricess. Surgical operation trauma stimulus is kept on the action in body, its strength changes continuously, the degree of the body stress reaction also changes continuously and immediately. Conduct and actions circulation the body of the function monitoring, the heart rate also wii change immediately with blood pressure. This research manifestation propofol group induction process is obvious more steady than isoflurane group at hemodynamics, explain the propofol TCI useds...