硬膜外阻滞复合全麻对于后腹腔镜手术术中应激反应的影响  

Effects of epidural block combined with general anesthesia on stress response under retroperitoneal laparoscopic surgery

作　　者：潘云松[1] 曹慧茹[1] 张焰[2] 

机构地区：[1]南京大学附属无锡二院麻醉科,214000 [2]苏州大学附属无锡四院麻醉科

出　　处：《临床麻醉学杂志》2010年第8期690-692,共3页Journal of Clinical Anesthesiology

摘　　要：目的比较硬膜外阻滞复合全麻(GEA)和全麻(GA)对后腹腔镜下手术术中应激反应的影响。方法 40例后腹腔镜下泌尿外科手术患者随机均分为GE组和GA组,均行异氟醚静吸复合全麻。GE组全麻诱导前行1.5%利多卡因加0.2%布比卡因硬膜外阻滞,麻醉平面维持在T4左右。分别于入室镇静后(T0)、气腹前(T1)、气腹后30min(T2)、60min(T3)、拔管后10min(T5)记录MAP、HR的变化,并测定血浆内皮素(ET)、降钙素基因相关肽(CGRP)浓度,记录异氟醚的吸入浓度。结果 T1～T3时,GE组MAP明显低于T0时,且明显低于GA组(P<0.05)。T5时两组HR均明显快于T0时(P<0.05)。T2、T3、T5时GE组ET、CGRP明显低于GA组(P<0.05)。T2、T3时GA组ET明显高于T0时(P<0.05)。T3时GA组CGRP明显高于T0时(P<0.05)。T1～T4时GE组异氟醚MAC值显著低于GA组(P<0.05),T2～T3时两组MAC值均显著高于T1时,T4时显著低于T1时(P<0.05)。结论与GA比较,GEA可以有效地减轻后腹腔镜下泌尿外科手术患者术中的应激反应。Objective To observe the effects of epidural block combined with general anesthesia （GEA） on stress response to retroperitoneal laparoseopic surgery. Methods Forty patients undergoing urological surgery under retroperitoneal laparoscopic were divided into two groups. The patients in group GA were given GA （general anesthesia with isoflurane inhalation） alone and those in group GE were given additional epidural block with a plane of T4. MAP, HR and isoflurane inhaled MAC were recorded, plasma endothelin （ET） and calcitonin gene-related peptide （CGRP） concentration were monitored before and after pneumoperitoneum. Results During operation, MAP, HR, ET and CGRP were significantly lower in group GE than those before and in group GA（P〈 0. 05）. Conclusion Compared to GA, GEA can effectively attenuate the strong stress response in patients undergoing urological surgery under retroperitoneal laparoscopiy.

关 键 词：后腹腔镜手术 硬膜外阻滞 内皮素 降钙素基因相关肽 应激反应 

分 类 号：R614[医药卫生—麻醉学]