两种途径给辅助药对皮质醇及β-内啡肽的影响

Effects of two regimens of injecting fentanyl on cortisol and beta-endorphin in patients undergoing abdominal surgery

目的 研究静脉及硬膜外腔应用芬太尼对下腹部手术患者血中皮质醇及β-内啡肽含量的影响。方法 选择30例病人，ASAⅠ～Ⅱ级，诊断为子宫肌瘤，择期在硬膜外麻醉下行全子宫切除术。随机分成静脉组和硬膜外组，每组15例。硬膜外麻醉平面固定后20min使用辅助药物，静脉组静脉注射芬太尼50μg，氟哌啶2．5mg；硬膜外组硬膜外腔注入芬太尼50μg，静脉注射氟哌啶2．5mg。分别于麻醉前、给辅助药后20、90min测定血中皮质醇及β-内啡肽。结果 β-内啡肽含量在使用辅助药后20min，两组均有显著下降（P〈0．01），而皮质醇含量在两组改变不明显。结论 两种途径给辅助药能抑制β-内啡肽的分泌，因而对应激反应可能有部分抑制作用。

Objective To investigate the effects of two regimens of injecting fentanyl during lower abdominal surgery on cortisol and beta-endorphin. Methods Thirty patients scheduled for elective laparohysterectomy were divided randomly into group Ⅰ （intravenous fentanyl 50μg, n=15） and group Ⅱ （epidural fentanyl 50μg,n=15）. The operations were all performed under epidural anesthe sia. Venous samples were taken to measure cortisol and β-endorphin by radioimmune assay at three time points： before operation, at 20 and 90 min after fentanyl. Results The plasma concentration of β-endorphin was lower significantly at 20 min after fentanyl in both groups than that before operation （P〈0.01）. But the concentration of cortisol was not changed significantly. Conclusion Two regimens of injecting fentanyl can inhibit the secretion of endorphin and depress the stress responses partly.