连续硬膜外腔阻滞对地氟醚麻醉期间交感神经活动的影响  

Effect of continuous epidural block on sympathetic neural activity during desflurane anesthesia

作　　者：张利萍[1] 孟秀丽[1] 蒋建渝 金清尘[1] 

机构地区：[1]北京医科大学附属第三医院麻醉科,100083

出　　处：《中华麻醉学杂志》2000年第8期467-470,共4页Chinese Journal of Anesthesiology

摘　　要：目的　观察连续硬膜外阻滞对地氟醚诱发交感神经兴奋性增强反应的预防作用。方法　 30例病人随机分为地氟醚组和连续硬膜外阻滞与地氟醚联合麻醉组 ,每组 15例。麻醉诱导气管内插管后 ,地氟醚组以挥发罐设定浓度 (FD) 2 %开始 ,并以每间隔 30s递增 1%的方法吸入地氟醚 氧 ,直至达到满足手术要求的浓度并维持麻醉 ;联合麻醉组在全麻诱导前于T9 10 或T10 11间隙行硬膜外穿刺置管 ,术中用利多卡因维持硬膜外阻滞 ,其余步骤同全麻组。于麻醉诱导前、吸入地氟醚30min后 (T1)、手术开始后 6 0min(T2 )及关腹膜后即刻 (T3 )分别抽取中心静脉血 ,采用高效液相色谱法测定血浆肾上腺素 (EPI)浓度和去甲肾上腺素 (NE)浓度。结果　与麻醉诱导前相比 ,吸入地氟醚后 5min ,地氟醚组MAP明显升高 ,而联合麻醉组MAP则明显降低 ,两组间差异显著。与基础值相比 ,于T1、T2 和T3 地氟醚组的EPI和NE水平明显升高 ,但联合麻醉组T1时EPI和NE的水平无显著性变化 ,T2 和T3 时亦明显升高 ,地氟醚组较联合麻醉组显著性升高。结论　连续硬膜外阻滞能有效地预防地氟醚诱发的交感神经兴奋性的增强反应。Objective To evaluate the prophylactic effect of continuous epidural block combined with desflurane anesthesia on increase of sympathetic neural activity induced by desflurane Methods Thirty patients were randomly allocated to two groups: desflurane anesthesia (DA) group (n=15) and epidural block combined with desflurane anesthesia (ECDA) group (n=15) After rapid induction with fentanyl propofol scoline, in DA group 2% desflurane in oxygen was inhaled firstly, then imposed with successive 1% increase of desflurane until balance and in ECDA group epidural blockade at T 9 10 or T 10 11 was firstly performed with 2% lidocain and other procedures were same as DA group The central venous blood samples were taken before induction, 30 min following desflurane inhalation(T 1), 60 min after operation beginning(T 2) and at the end of operation(T 3), to measure the plasma conentrations of catecholamine with high performance liquid chromatography Results Compared with baseline, following desflurane inhalation, MAP increased in DA group, but decreased in ECDA group, with significant difference between both groups As compared with the baselines, plasma epinephrine (EPI) and norepinephrine (NE) concentrations increased significantly in DA group at T 1, T 2 and T 3, but in ECDA group remained unsignificant changes at T 1, rose markedly at T 2 and T 3 EPI and NE levels were evidently higher in DA group at T 1 and T 2 than those in ECDA group Conclusions Continuous epidural blockade can effectively prevent the increasing in sympathetic neural activity induced by desflurane

关 键 词：地氟醚 交感神经系统 连续硬膜腔阻滞 

分 类 号：R614.42[医药卫生—麻醉学] R971.2[医药卫生—外科学]