小儿围术期应激反应的实验室监测及其意义

Monitoring of stress response in infants during operation and its clinical significance

目的 ::分析患儿围术期应激反应的差异以及不同的麻醉方式对应激程度的影响 ,探讨降低应激程度的麻醉方式。方法 :美国麻醉医师协会 (ASA)Ⅰ～Ⅱ级患儿 2 0例 ,其中实验组 10例 ,采用 0 .3%罗哌卡因单次骶管阻滞复合全麻 ,对照组 10例 ,行单纯全麻 ;ASAⅢ级患儿 10例均行单纯全麻。所有患者均于麻醉前、切皮后 5min、切皮后 6 0min、术毕、术后 2 4h抽取静脉血检测ACTH ,COR ,IL 6 ,CRP。结果 :ASAⅢ级患儿血浆ACTH、COR、IL 6于术毕、术后 2 4h明显高于ASAⅠ～Ⅱ级患儿 ,CRP术后 2 4h明显高于ASAⅠ～Ⅱ级患儿 (P <0 .0 1) ;ASAⅠ～Ⅱ级实验组与对照组患儿血浆ACTH、COR、IL 6、CRP差别不显著。结论 :同时检测围术期血浆ACTH、COR、IL 6、CRP含量的变化 ,有利于观察患儿在围术期的应激反应程度 ,0 .3%罗哌卡因单次骶管阻滞复合全麻不能减轻小儿围术期的应激反应。

Objective: To study the difference of stress response between ASA Ⅰ to Ⅱ and ASA Ⅲ infants, and the influence of stress r esponse in different anesthesia ways, so as to find a new anesthesia way which c an diminish stress response during operation. Methods:Twenty patients (classified as ASA Ⅰ to Ⅱ) were randomly assigned into 2 groups. Test group (n=10) received 0.3 percent ropivacaine caudual block anesthesia, and control group(n=10) received anesthesia. Ten patients (classified as ASA Ⅲ ) received anesthesia too. The venous blood samples were taken from all the pati ents before anesthesia, 5 minutes after dermatomy, 60 minutes after dermatomy, p ostoperation, 24 hours after operation. Results:The levels of plasma ACTH,COR,IL-6 in ASA Ⅲ group were higher than those in ASA Ⅰ to Ⅱ g roup in postoperation and 24 hours after operation, andCRPwas hi gher than that in ASA Ⅰ to Ⅱ group 24 hours after operation(P<0.01). The p atients of test group were compared with those of control group in ASA Ⅰ to Ⅱ. The levels of Plasma ACTH,COR,IL-6,CRP had no significant difference in two gr oups(P>0 05). Conclusion:The levels of plasma ACTH,COR, IL-6,CRP were measured at the same time during operation, which can help surgeo ns observe the extent of stress response of patients. It is meaningful for patie nts to recover after operation. Ropivacaine caudual(0.3%) block anesthesia can ’t diminish the stress response during operation in infants.