芬太尼复合甲磺酸罗哌卡因硬膜外麻醉对下腹部手术应激反应的影响  

Effects of epidural ethanesulfonic acid ropivacaine combined with fentanyl on stress response in the operation of hypogastric zone

作　　者：刘鹏斌[1] 

机构地区：[1]西安交通大学医学院第二附属医院麻醉科,陕西西安710004

出　　处：《西安交通大学学报（医学版）》2007年第6期693-695,699,共4页Journal of Xi’an Jiaotong University（Medical Sciences）

摘　　要：目的研究芬太尼复合甲磺酸罗哌卡因硬膜外麻醉对下腹部手术应激反应的影响。方法60例选择性下腹部手术患者,随机分为两组:甲磺酸罗哌卡因复合芬太尼组(研究组,n=32)和甲磺酸罗哌卡因组(对照组,n=28)。硬膜外穿刺部位均为L1-2间隙,每组硬膜外首剂量均为20 g/L利多卡因5 mL(试验量),随后加入8.94 g/L甲磺酸罗哌卡因12 mL,研究组复合芬太尼0.1 mg(2 mL),对照组复合生理盐水2 mL。记录术前、术中血压、心率变化,测定麻醉前、切皮后60 min、切皮后90 min的血清肾上腺素、去甲肾上腺素、皮质醇、胰岛素和血糖水平。结果切皮后60 min、切皮后90 min的血清肾上腺素、去甲肾上腺素、皮质醇水平均高于术前(P<0.05),切皮后60 min、切皮后90 min的肾上腺素、去甲肾上腺素、皮质醇和血糖水平对照组高于研究组(P<0.05)。研究组血糖浓度在切皮后60 min和90 min与术前相比无明显变化(P>0.05),对照组血糖浓度在切皮后60 min和90 min与术前比较均明显增高(P<0.05)。结论芬太尼和甲磺酸罗哌卡因复合应用于连续硬膜外麻醉能够减轻下腹部手术时应激反应所导致的肾上腺素、去甲肾上腺素、皮质醇和血糖水平增高。Objective To investigate the effects of epidural ethanesulfonic acid ropivacaine combined with fentanyl on stress response in the operation of hypogastric zone. Methods Sixty patients （ASA Ⅰ- Ⅱ） scheduled for the operation on hypogastric zone were divided randomly into two groups. Epidural puncture and catheterization were carried out routinely and 8.94 g/L ethanesulfonic acid ropivacaine （control group） and that with 0. lmg fentanyal （research group） was used for epidural block. Blood pressure, heart rate, adrenaline, noradrenaline, cortisol, insulin and blood sugar level at defined time were measured and compared. Results 60 min and 90 min after skin incision, the levels of adrenaline, noradrenaline and cortisol in the blood were higher than those before the operation （P〈0.05）. Besides, at the above time points, the contents of adrenaline, noradrenaline, cortisol and blood sugar in the research group were higher than those in the control group （P〈0.05）. Blood sugar content did not change significantly 60 min and 90 min after skin incision in the research group （ P 〉 0.05）, but increased significantly in the control group （P〈0.05）. Conclusion Epidural ethanesulfonic acid ropivacaine combined with fentanyal could relieve the increase of adrenaline, noradrenaline, cortisol and blood sugar content resulting from stress response in the operation of hypogastric zone.

关 键 词：甲磺酸罗哌卡因 芬太尼 硬膜外阻滞 应激反应 下腹部手术 

分 类 号：R619[医药卫生—外科学]