全麻复合硬膜外阻滞对换瓣手术病人术后血浆皮质醇、血糖及术后恢复的影响  

Effects of epidural blockade combined with general anesthesia on plasma levels of cortisol,blood glucose and postoperative recovery in patients undergoing cardiac valve replacement

作　　者：何亮[1] 钱燕宁[1] 陈宇[1] 陈平[1] 林桂芳[1] 

机构地区：[1]南京医科大学第一附属医院麻醉科,210029

出　　处：《临床麻醉学杂志》2006年第2期102-105,共4页Journal of Clinical Anesthesiology

基　　金：江苏省医学重点人才项目(RC2002058)

摘　　要：目的观察全麻复合硬膜外阻滞对心脏瓣膜置换手术病人血浆皮质醇(Cor)、血糖(Glu)及术后恢复的影响。方法将20例换瓣手术病人随机分为全麻复合硬膜外阻滞(GEA)和单纯全麻(GA)两组。于术前、术后4 h、术后第1、3、7天取血浆测Cor、Glu浓度,并记录术后清醒时间和拔管时间。结果与术前比较,GA组病人术后4 h,术后第1天血浆Cor水平均显著升高(P<0.05),GEA组血浆Cor水平仅在术后4 h显著增高(P<0.05),但其术后4 h,术后第1天的血浆Cor水平明显低于GA组(P<0.05)。术后第1天,GEA组血浆Cor水平即恢复致术前水平,GA组至术后第3天才恢复致术前水平。两组病人Glu从术后4 h至第7天均高于麻醉前水平,GEA组升高的幅度小于GA组,在术后各时点两组之间差异有显著意义(P<0.05)。GEA组病人术后清醒时间、术后拔管时间早于GA组(P<0.05),术后VAS显著低于GA组(P<0.05)。结论全麻复合硬膜外阻滞可减轻心脏换瓣手术病人应激反应和术后疼痛,有利于病人术后早清醒与早拔管。Objective To study the effects of epidural blockade combined with general anesthesia （IGEA） on stress reponse and postoperative recovery in patients undergoing cardiac valve replacement. Methods Twenty patients were randomly assigned to two groups with 10 cases each. The patients in group GEA received epidural anesthesia combined with general anesthesia and those in contril group underwent traditional general anesthesia （GA） as the control. Plasma levels of eortisol and blood glucose （Glu） were measured before induction of anaesthesia, at 4 hours after the end of surgery, on the 1st, 3rd and 7th postoperative day. Results All the patients survived. The levels of eortisol at 4h after the end of surgery and on the 1st postoperative day were significantly lower in group GEA than those in group CA （P〈0.05）. The levels of Glu were significantly lower in group GEA than those in group GA at all postoperative time points. The patients in group GEA had lower visual analog scores（VAS） at coughing and rest （P〈0.05）,and were extubated earlier （P〈0.05）. but there was no difference in the length of stay in ICU between group GEA and group GA. Conclusion Epidural blockade combined with general anesthesia attenuates the stress response and postoperative pain, and is beneficial to early tracheal extubation in patients undergoing cardiac valve surgery.

关 键 词：硬膜外阻滞 应激反应 术后镇痛 

分 类 号：R614[医药卫生—麻醉学]