全麻复合硬膜外阻滞对胸科手术病人儿茶酚胺的影响

Effects of general anesthesia combined with epidural block on plamsa catecholamines in patients undergoing thoracic surgery

目的观察单纯全身麻醉(GA)和全麻复合硬膜外阻滞(GEA)用于胸部手术对病人血浆儿茶酚胺浓度的影响。方法将30例肺叶切除手术病人随机分为GA和GEA两组,分别于手术前1d,切皮后45、90、135min,术后第1d测定血浆儿茶酚胺浓度。结果NE与术前基础值比较,GEA组术中术后各时点无明显升高;GA组术中明显升高,术后1d达峰。E与术前基础值比较,两组各时点均无明显变化。结论全麻复合硬膜外麻醉下施行胸部手术能减少NE的分泌,从而减轻患者术中应激反应。

Objective To study the effects of general anesthesia combined with epidural block （GEA） and pure general anesthesia （GA） on catecholamines in patients undergoing thoracic surgery. Methods Thirty patients submitted to elective pulmonary surgery were randomly divided into two groups of 15 patients： GEA group receiving general anesthesia combined with thoracic epidural block and GA group receiving only general anesthesia. Epinephrine （E） and norepinephrine （NE） levels were respectively measured in the last day before operation, at 45 min, 90 min and 135 min after incision, and in the 1st postoperative day. Results The concentration of NE in the GA group increased gradually at every time point after incision, then reached the peak values in the 1st postoperative day; it was significantly higher than the preoperative level （P〈0. 05）, while the concentration of NE did not increased significantly in the GEA group （P〉0. 05）. There were non-significant increases of E levels in two groups during surgery （P〉0.05）. Conclusion General anesthesia combined with epidural block can markedly suppress the response to stress by preventing NE increases in response to surgery.