慢性脊髓损伤患者无麻醉下行损伤平面以下手术时应激变化  

The Stress Hormone Responses of Patients with Chronic Spinal Cord Injury Who Undergo the Operations without Anesthesia below the Level of Injury

作　　者：李正[1] 朱涛[1] 纪键[1] 赵曦[1] 李清[2] 

机构地区：[1]上海交通大学附属第一人民医院松江分院麻醉科,上海201600 [2]湖北省十堰市太和医院麻醉科,湖北十堰442000

出　　处：《中国临床医学》2008年第3期413-415,共3页Chinese Journal of Clinical Medicine

摘　　要：目的:分析慢性脊髓损伤患者无麻醉下进行损伤平面以下手术与相应节段硬膜外麻醉下无脊髓损伤患者的手术,观察血流动力学参数、去甲肾上腺素和皮质醇等指标变化。方法:试验组(SCI组)为慢性脊髓完全损伤患者,在无麻醉情况下行损伤平面以下择期手术;对照组(EA组)为无脊髓损伤在相应节段硬膜外麻醉下实施手术的患者,两组各12例。分别于术前、术中和术后1h记录动脉收缩压(SAP)和心率(HR),计算平均值(0～1/2h,1/2～1h,术后1h均值)。于麻醉前(T0)、切皮时(T1)、手术开始后30min(T2)、手术开始后60min(T3)、术后1h(T4)5个时点分别取血测定血浆去甲肾上腺素浓度和血浆皮质醇浓度。结果:术前两组患者的SAP和HR无显著差异(P>0.05);但术中0～1/2h时SCI组SAP和HR明显高于EA组(P<0.05);术中1/2～1h时组间比较无差异(P>0.05);而术后1h时EA组的SAP和HR明显高于SCI组(P<0.05),EA组与基础值比较有显著差异(P<0.05)。在T0和T1时SCI和EA组血浆去甲肾上腺素和皮质醇浓度的变化无显著差异(P>0.05);在T2SCI组血浆去甲肾上腺素和皮质醇浓度明显高于EA组及自身的基础值(P<0.05);T3时SCI组血浆去甲肾上腺素虽有降低,但仍明显高于EA组及自身的基础值(P<0.05);T4时SCI组血浆去甲肾上腺素和皮质醇浓度保持相对稳定,仍高于自身的基础值(P<0.05),而EA组去甲肾上腺素和皮质醇浓度这时明显升高,不仅高于自身的基础值(P<0.05),并且明显高于SCI组(P<0.05)。结论:脊髓损伤患者在无麻醉情况下行损伤平面以下手术时存在明显的应激反应。Objective：To investigate the difference between the patients with chronic spinal cord injury who undergo the operations below the level of injury with no anesthesia and the patients with no spinal injury who undergo the operations with epidural anesthesia at the same level.To observe the change of the index including haemodynamics parameter,noradrenaline and hydrocortisone.And to study the possible mechanisms and provide the anaesthesia basis for this kind of patients in clinic.Methods：Experiment group was the patients with chronic spinal cord injury（SCI group） who undergo the operations below the level of injury with no anesthesia.The control group is the patients with no spinal injury who undergo the operations with epidural anesthesia（EA group） at the same level.12 patients for each group.Record SAP and HR 1 hour before,in and after the operative,Respectively.Calculate the mean number（0-1/2h,1/2h-1h,1h after the operation）.Serum concentrations of norepinephrine and hydrocortisone were measured before anaesthesia（T0）,when cutting skin（T1）,30 minutes after the beginning of the operation（T2）,60 minutes after the beginning of the operation（T3） and 1 hour after the end of the operation（T4）,5 time points,respectively.Results：There was no significant difference in SAP and HR with two groups.（P〉0.05）,but during the time of 0-1/2h in the operation,SAP and HR of SCI group were significant higher than that of EA group（P〈0.05）;There was no statistical meaning during the time of 1/2-1h in the operation.（P〉0.05）;however,during the time of 1 hour after the operation,SAP and HR of EA group were significantly higher than that of SCI group（P〈0.05）.There was significantly difference between EA goup and the basic number（P〈0.05）.At T0 and T1,there was no significantly difference between SCI group and EA group in the change of the serum concentrations of norepinephrine and hydrocortisone（P〉0.05）;At T2,the serum concentrations of norepinephrine and hydrocortis

关 键 词：慢性脊髓损伤 麻醉 应激 

分 类 号：R651.2[医药卫生—外科学]