不同麻醉方式对45例患儿术中应激反应影响的观察  

Influence of different anesthetic methods on the stress response of children during operations

作　　者：王晖[1] 张昕[1] 秦秦[1] 

机构地区：[1]陕西省人民医院麻醉科,西安710068

出　　处：《陕西医学杂志》2007年第9期1178-1181,共4页Shaanxi Medical Journal

摘　　要：目的:探讨不同麻醉方式对小儿下肢及下腹部手术应激反应的影响。方法:将45例择期行下肢或下腹部手术患儿随机分为3组,分别采用氯胺酮复合羟丁酸钠静脉全麻(Ⅰ组),单次硬膜外麻醉(Ⅱ组)和骶管阻滞麻醉(Ⅲ组)。每组病例数均为15例。分别于入室时(T0)、切皮后30min(T1)及切皮后60m in(T2)采血,检测血糖、皮质醇、肾上腺素及去甲肾上腺素浓度,并记录术中患儿平均动脉压及心率变化情况。结果:Ⅰ组患儿血糖在T1、T2时点明显高于Ⅱ、Ⅲ组患儿(P<0.05)。Ⅰ组患者T2时点皮质醇水平较T0显著增高(P<0.05),Ⅱ、Ⅲ组患儿皮质醇水平无明显改变(P>0.05)。Ⅰ组患儿T2时肾上腺素水平较T0时明显升高(P<0.05),T1、T2时去甲肾上腺素水平较T0显著升高(P<0.05)。结论:单次硬膜外麻醉与骶管阻滞抑制小儿术中应激反应的效果较氯胺酮复合羟丁酸钠静脉全麻好。Objective： To study the effects of different anesthetic methods on the stress response of children during operations. Methods： 45 children undergone lower limb or low abdominal operations were randomly divided into intravenous generalized anesthesia group （group Ⅰ ,n= 15）, single epidural anesthesia group （group Ⅰ ,n = 15） and caudal block group （group Ⅰ ,n = 15）. Blood samples were obtained after entering the operation room, 30min after incision and 60min after incision. The concentrations of blood glucose, cortisol , epinephrine and norepinephrine were measured. The changes of MAP and HR were also recorded. Results： The blood glucose of group Ⅰ at T1 .T2 was higher than that of group Ⅱ and Ⅲ （P〈0.05）. In group Ⅰ, the serum cortisol level increased more significantly at T2 than at T0 （P〈0. 05）, with no apparent changes in group Ⅰ and Ⅱ （P〉0.05）. In group Ⅰ , the level of epinephrine was significantly increased at T2, and the level of norepinephrine was significantly increased at T1 and T2 （P〈0. 05）. Conclusion： The functions of inhibition of stress responses of single epidural anesthesia and caudal block are better than that of intravenous generalized anesthesia.

关 键 词：麻醉 静脉 麻醉 硬膜外 氯胺酮/治疗应用 羟丁酸钠/治疗应用 应激 对比研究 儿童 

分 类 号：R473.6[医药卫生—护理学]