全麻复合硬膜外阻滞对上腹部手术患者应激激素和白介素-10的影响

Effect of Combined General Anesthesia with Epidural Block on the Stress Response in Patients Undergoing Upper Abdominal Surgery

目的 观察全麻复合硬膜外阻滞对上腹部手术患者应激反应的影响。方法 2 6例择期行上腹部手术的患者 ,随机分为全麻复合硬膜外阻滞组和单纯全麻组 ,每组 13例。分别测定麻醉前、切皮时、切皮后 1h、术毕拔管时血浆皮质醇、血管紧张素Ⅱ、β 内啡肽和白介素 10水平。结果 血浆皮质醇在拔管时两组均高于麻醉前 (P <0 0 5 ) ;在切皮时、切皮后 1h ,单纯全麻组明显高于全麻复合硬膜外阻滞组 (P <0 0 5 ) ;与麻醉前基础值比较 ,全麻复合硬膜外阻滞组术中无明显升高。全麻复合硬膜外阻滞组拔管时血管紧张素Ⅱ高于麻醉前 (P <0 0 5 ) ;单纯全麻组切皮后 1h、拔管时均较麻醉前升高 (P <0 0 5 )。两组患者 β 内啡肽术中、拔管时均上升 ,与麻醉前比较单纯全麻组升高明显 (P <0 0 5 )。两组患者白介素 10术中、拔管时均呈上升趋势 ,组间比较差异不明显 (P >0 0 5 )。

Objective To evaluate the influence of combined general anesthesia with epidural block on the stress response to upper abdominal surgery.Methods Twenty-six ASA Ⅰ-Ⅱ patients undergoing upper abdominal surgery were randomized to receive either combined general anesthesia with epidural block (group GEA, n=13) or general anesthesia (group GA,n=13). In GEA group epidural block was performed before general anesthesia at T 8-9. Anesthesia was induced with midazolam 0.1 mg/kg, propofol 1～2 mg/kg, fentanyl 2～4 μg/kg and vecuronium 0.1 mg/kg, and maintained with inhalation of 1%～2% isoflurane, intermittent iv boluses of vecuronium and epidural infusion of 1.5% lidocaine (5 ml/h). In GA group the induction and maitenance of anesthesia were done by the same procedure except without epidura infusion. Blood samples were taken before anesthesia, at incision, one hour after incision and at the end of surgery for determination of serum concentration of cortisol (COR), angiotension (AⅡ), β -endorphin (β-EP) and interleukin-10 (IL-10). Results Compared with the baseline value before anesthesia, serum COR increased significantly at the end of surgery in both groups. And at incision and one hour after incision, CORs in GA group were higher than that in GEA group (P<0.05), while AⅡincreased significantly one hour after incision and at the end of surgery in GA group (P<0.05). Compared with the baseline value, β -EP and IL-10 increased during and at the end of surgery in both groups, and β -EP increased significantly in GA group (P<0.05), while there was no significant difference between the two groups for IL-10. Conclusion Combined general anesthesia with epidural block can reduce but cannot eliminate the stress response in patients undergoing upper abdominal surgery.