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目的探讨地氟醚的交感兴奋作用及其机理。方法择期手术病人３０例，ＡＳＡⅠ～Ⅱ级，随机分为地氟醚（１５例）、异氟醚（１５例）两组。不用术前药。气管插管后观察不同地氟醚和异氟醚水平（０．５ＭＡＣ、ＯＭＡＣ和１．５ＭＡＣ）对平均动脉压（ＭＡＰ）和心率（ＨＲ）、心率变异性（ＨＲＶ）和用改良荧光法测定血浆中肾上腺素（Ｅ）、去甲肾上腺素（ＮＥ）浓度的影响。结果二组ＭＡＰ、ＨＲ、Ｅ和ＮＥ在麻醉前、０．５ＭＡＣ和１．０ＭＡＣ时无差异（Ｐ＞０．０５），达１．５ＭＡＣ后地氟醚组则出现２～４ｍｉｎ的ＭＡＰ增高和ＨＲ增快，且血浆Ｅ和ＮＥ浓度升高，明显高于异氟醚组（Ｐ＜０．０５），而异氟醚组无变化。ＨＲＶ的总功率（ＴＰ）、低频（ＬＦ）和高频（ＨＦ）二组都随着ＭＡＣ的增加逐渐降低，但在１．５ＭＡＣ时与异氟醚组相比，地氟醚组ＨＦ明显降低，ＬＦ／ＨＦ明显升高（Ｐ＜０．０５）。结论快速增加地氟醚浓度至１．５ＭＡＣ可出现交感兴奋作用，其作用机制可能是迷走神经受抑制超过交感神经的抑制程度。
Objective To investigate the sympathetic excitability and its mechanism of desflurane. Methods Thirty patients with ASA Ⅰ ~ Ⅱ were randomly divided into two groups: desflurane (15 cases) and isoflurane (15 cases). No preoperative medicine. After tracheal intubation, mean arterial pressure (MAP) and heart rate (HR), heart rate variability (HRV) were measured at different levels of desflurane and isoflurane (0.5MAC, OMAC and 1.5MAC) Effects of plasma epinephrine (E) and norepinephrine (NE) concentrations. Results MAP, HR, E and NE in the two groups had no significant difference before anesthesia, at 0.5MAC and 1.0MAC (P> 0.05), but MAP increased after 2-4M in desflurane group HR increased, and plasma E and NE concentrations increased significantly higher than the isoflurane group (P <0.05), while the isoflurane group did not change. The total power (TP), low frequency (LF) and high frequency (HF) of HRV decreased gradually with the increase of MAC, but the HF of desflurane group was significantly decreased at 1.5MAC compared with isoflurane group , LF / HF increased significantly (P <0.05). Conclusion The rapid increase of desflurane concentration to 1.5MAC sympathetic excitement may occur, the mechanism may be vagus nerve inhibition over sympathetic inhibition.