不同麻醉法对血浆肾素、血管紧张素Ⅱ、醛固酮、皮质醇水平的影响

Influence of different anesthesia on plasma levels of renin, augiotension, aldosterone and cortisol

观察全麻复合硬膜外阻滞和全麻两种麻醉时血浆肾素、血管紧张素Ⅱ、醛固酮、皮质醇变化。２５例择期上腹部手术患者，随机分两组：Ａ组为全麻复合硬膜外阻滞１２例，Ｂ组为全麻１３例。分别于麻醉前、麻醉插管后２分钟、进腹探查时、术中２小时、拔管后即刻抽取中心静脉血测肾素、血管紧张素Ⅱ、醛固酮、皮质醇的浓度。结果示Ａ组麻醉前后无明显变化（Ｐ＞０．０５）；Ｂ组术中肾素活性和皮质醇显著增高（Ｐ＜０．０１）。此外，手术期间Ａ组比Ｂ组心率慢，血压低（Ｐ＜０．０１）。表明全麻复合硬膜外阻滞是一种应激反应较轻的麻醉方法。

To observe the changes of concentrations of angiotension Ⅱ (AG Ⅱ ), renin(RE ),aldosterone (ALD),and cortisol(COS) under combination of general and epldural anesthesia(CGEA) or general anesthesia (GA), 25 adult IJaticnts,ASA grade Ⅰ to Ⅱ, sheduled for elective upper abdominal surgery,werc randomly assigned to receiving CGEA (group A) or GA(group B),respectively. The general anesthesia was induced with intravenous injectioll of valium 0. 3 mg/kg .thiopental 5 mg/kg,pancuronium 0. 1 aug/kg and fentanyl 5μg/kg, and mintained with inhalation of isofluranc and intermittent bolus of pancuronium. The epidural block was Produced by epidural administration of 0. 5% buplvacaine 12-15 ml every 90 mins. Tile venous blood samples were taken before anesthesia, and at various times during anesthesia separately, in which foe plasma concentrations of RE. AG Ⅱ, ALD and COS were measured by radioimmunoassay. The results demonstrated that in group B,the RE level increased significantly during surgical exploration,and was ascended to the peak value at 2nd hour during operation (P<0. 05 ) );the COS level rose markedly at 2nd hour bluring operation and immediately after extubation (P<0. 05);the concentrations of AG 1 and ALD kept statistically unchanged during entire process (P>0. 05 ); in group A. the above plasma concentrations remained stable during whole procedures (P> 0. 05 ) ). As compared with those in group B,the level of RE reduced dramatically during surgical exploration and 2 hours following operation, and one of COR was descended obviously 2 hours following operation and after extubation (PRO. 01 ). It is suggested that the combination of general and epidural anesthesia can depress greatly the stress responses to operative stimulation.