两种不同麻醉方式对患者围手术期应激的影响  

Stress in perioperative period of two different anesthesia methods

作　　者：仲勇[1] 周嘉[1] 袁岚[1] 

机构地区：[1]上海中医药大学附属曙光医院麻醉科,上海201203

出　　处：《上海交通大学学报（医学版）》2013年第12期1681-1683,1688,共4页Journal of Shanghai Jiao tong University:Medical Science

基　　金：上海市卫生局三年行动计划重大研究项目(ZYSNXD-CC-ZDYJ014)~~

摘　　要：目的探讨两种不同麻醉方式对患者围手术期应激的影响。方法按配对设计原则选择腹部手术治疗的患者62例，分为单纯全身麻醉组（A组）和全身麻醉复合硬膜外阻滞组（B组），每组31例，分别于麻醉诱导前（T1）、手术开始后30min（T2）、关腹后（T3）和术后24h（T4），记录患者心率、平均动脉血压（MABP），测血浆去甲肾上腺素（NE）、血清皮质醇（Cor）和血清C反应蛋白（CRP）浓度。术后记录患者手术时间及出血量。结果两组患者手术时间和出血量比较差异均无统计学意义（P〉0．05）；T1、T2和T3时间点，B组患者MABP均低于A组患者（P〈0．05），T4时两组患者MABP比较差异无统计学意义（P〉0．05）；T1～T4各时间点两组患者心率比较差异无统计学意义（P〉0．05）；T1时间点，B组NE水平明显高于A组（P〈0．01）。但两组间Cor、CRP比较差异无统计学意义（P〉0．05）；T2、T3、T4时间点，B组NE、Cor和CRP水平均显著低于A组（P〈0．01或P〈0．05）。结论全身麻醉复合硬膜外阻滞较单纯全身麻醉更能降低患者围手术期应激反应。Objective To explore stress in perioperative period of two different anesthesia methods. Methods According to matching design, 62 patients underwent abdominal surgery were selected and divided into general anesthesia group （ group A） and general anesthesia combined with epidural block group （ group B） with 31 in each. Heart rate （ HR）, mean arterial blood pressure （MABP）, plasma norepinephrine （NE）, serum cortisol （Cor）, and serum C-reactive protein （CPR） concentration were measured in the beginning of anesthesia （T~）, 30 rain after beginning （T2）, abdominal suture （T3）, and 24 h after operation （T4）. Operation time and amount of bleeding were recorded. Results There were no significant differences of operation time and bleeding between the two groups （P 〉 0.05）. Compared to group A, MABP values were significantly lower in patients of group B in T1, T2, and T3 time points （P 〈 0.05）, but MABP values were similar in T4 （P 〉 0.05）. The HR values were normal in both groups. In T~, the NE levels of B group were significantly higher （P 〈0.01）, but there were no significant differences of Cor and CRP values. In T2, T3, and T4 time points, the NE, Cor, and CRP values were significantly lower in group B than those of group A （P 〈 0.05, P 〈 0.01）. Conclusion General anesthesia combined with epidural block may reduce perioperative stress response compared to general anesthesia.

关 键 词：全身麻醉 硬膜外阻滞 去甲肾上腺素 皮质醇 C反应蛋白 

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