硬膜外阻滞复合全身麻醉对血浆儿茶酚胺的影响  

The Effect of Epidural Block Combined with General Anesthesia on Plamsa Catecholamines

作　　者：葛宁花[1] 薛张纲[1] 蒋豪[1] 

机构地区：[1]复旦大学附属中山医院麻醉科,上海200032

出　　处：《中国临床医学》2001年第2期150-152,共3页Chinese Journal of Clinical Medicine

摘　　要：目的 :探讨硬膜外阻滞复合全身麻醉对机体应激反应的影响。方法 :随机选择ASAⅠ～Ⅱ级的肝癌和食管癌病人 88例 ,分成两组 :W组 (44例 )在诱导前硬膜外导管不加药 ,Y组 (44例 )则加入 0 .5 %的布比卡因 4ml,测定诱导前后的血压、心率、肾上腺素和去甲肾上腺素的值。结果 :两组的心率和血压在诱导后 (插管前 )显著降低 ,Y组尤为显著 (P <0 .0 5 )。插管后Y组血压略有升高 ,而W组插管后血压明显上升 ,与Y组比较有统计学意义 (P <0 .0 5 ) ;在插管前W组的儿茶酚胺显著高于Y组 (P <0 .0 5 )。插管后 5min两组的儿茶酚胺都升高 ,W组尤为明显。插管后 1h ,Y组的肾上腺素和去甲肾上腺素的含量略增加 (P >0 .0 5 ) ,而W组比插管后低 (P <0 .0 5 )。结论 :硬膜外阻滞复合全麻能减少血浆CA的释放 ,在保持机体适度的应激反应能力的同时 ,控制亢进的反应。Objective: To study the effect of epidural block combined with general anesthesia on plasma catecholamines. Methods: Eighty-eight patients undergone elective surgery for liver and esophageal cancers were selected to study the effects of epidual block combined with general anesthesia on plasma catecholamines levels during operation. Patients were randomly allocated into Y group ( n =44) and W group ( n =44). The difference between Y group and W group was that the patients in Y group received epidural anesthesia to T 2-4 sensory level before induction. All the patients were induced with propofol, fentanyl and succinylcholine and were maintained with O 2, propfol and vecuronium. After intubation, W group began and Y group continued to receive epidual block. Epinephrine (E) and norepinephrine (NE) levels were measured before epidual activation ,before general induction ,5 minute and 60 minute after intubation. Results: There was a decrease ( P <0.05) in NE and E in the Y group before induction. The W group had significantly higher levels of NE and E than the Y group 5min after intubation. NE and E levels remained stable in Y group 60 min, but large ( P <0.05) decrease in W group. Conclusion: This study shows that epidural anesthesia to T 2-4 prevents NE and E increases in response to intubation and surgery. Epidural block combined with general anesthesia can markedly suppress the response to stress, but it is unable to block all the afferent neural output arising from the operation.

关 键 词：联合麻醉 血流动力学 应激反应 儿茶酚胺 硬膜外麻醉 全身麻醉 

分 类 号：R614.27[医药卫生—麻醉学] R614.42[医药卫生—外科学]