胸段硬膜外阻滞复合全麻对非体外循环冠状动脉搭桥术患者应激反应的影响  

Effects of Thoracic Epidural Anesthesia Combined with General Anesthesia on the Stress in Patients Undergoing Off-pump Coronary Artery Bypass Grafting

作　　者：王明山[1] 尹燕伟[1] 华震[1] 于文刚[1] 宋建放[1] 王世端[1] 

机构地区：[1]青岛大学医学院附属医院,266003

出　　处：《青岛医药卫生》2006年第1期1-4,共4页Qingdao Medical Journal

摘　　要：目的比较单纯全麻和胸段硬膜外阻滞复合全麻对非体外循环冠状动脉搭桥术患者应激反应的的影响。方法选择非体外循环冠状动脉搭桥手术的患者作为研究对象,观察组15例,对照组15例。观察组于手术前一天行T4-5硬膜外穿刺置管,用0．8％利多卡因,确认硬膜外阻滞有效后再行全麻诱导插管。对照组不做硬膜外阻滞。分别于手术开始前、结束后1h、结束后24h及结束后48h各抽取动脉血5ml,分离出血浆冷藏,用放射免疫分析法检测血浆标本中内皮素(ET)、白介素-6、白介素-8、白介素-10及肿瘤坏死因子(TNF-α)值。结果两组血浆中ET,TNF-α,IL-6,IL-8和IL-10水平在术前差异无显著性(P>0．05),对照组术后ET,TNF-α,IL-6,IL-8和IL-10水平明显升高,与麻醉诱导后相比,差异有显著性(P< 0．05),术后24h时后开始下降。观察组术后TNF-α,IL-6,IL-8,IL-10水平也较术前显著升高(P<0．05),与对照组相比,差异有显著性(P<0．05)。结论高胸段硬膜外阻滞复合全麻相对于单纯全麻能明显降低非体外循环冠状动脉搭桥手术患者的应激反应。Objective To study the effects of thoracic epidural anesthesia combined with general anesthesia on the stress in patients undergoing off-pump coronary artery bypass grafting. Methods 30 patients scheduled for off-pump coronary bypass grafting were divided randomly into two groups. 15 of them were given thoracic epidural anesthesia plus general anesthesia with 0.8% lidocaine as the study group. The others as the control group received general anesthesia only. 5ml artery blood samples were obtained before operation,at the end of operation 1h,24h and 48h after operation for determination of plasma ET, IL-6,IL-8,IL-10 and TNF-α. Results The plasma levels of ET,IL-6,IL-8,IL-10 and TNF-α were significantly lower in the study group than those in the control group. Conclusion Compared with general anesthesia alone, thoracic epidural anesthesia combined with general anesthesia can attenuate the stress response to surgery in the patients undergoing off-pump coronary artery bypass grafting.

关 键 词：冠状动脉搭桥术 全麻胸段硬膜外阻滞 应激反应 

分 类 号：R614.2[医药卫生—麻醉学] R654.2[医药卫生—外科学]