七氟醚全麻复合硬膜外阻滞与镇痛对胸科手术应激反应的影响

Effects of sevofrane general anesthesia combined with epidural blockade and PCEA on the stress response to major thoracic surgery

目的观察评估七氟醚全麻复合硬膜外腔阻滞与镇痛对胸科手术应激激素和细胞因子的影响。方法选择20例开胸手术病人,随机分为两组,每组各10例,即全麻复合硬膜外腔阻滞组和全身麻醉组,分别测定麻醉诱导前、手术2、4h、术毕、术后1d及术后3d的血浆去甲肾上腺素、肾上腺素、血清促肾上腺皮质激素、皮质醇、C-反应蛋白、白细胞介素-6及白细胞介素-10的水平。结果血浆去甲肾上腺素和血清皮质醇全麻复合硬膜外腔阻滞组术中术后无显著改变,但全麻组术毕和术后1d显著升高(P<0.05),术后3d恢复至术前水平,组间比较前者有显著差异(P<0.05)。两组血浆肾上腺素、白细胞介素-10术中术后均无显著变化。两组血清促肾上腺皮质激素、白细胞介素-6及C-反应蛋白术中术后均显著升高(P<0.05),组间比较无显著差异(P>0.05)。结论硬膜外腔阻滞及术后硬膜外腔自控镇痛可以减轻胸部手术的应激反应。

Objective To observe evaluate the influence of epidural blockade and PCEA on the stress response to major thoracic surgery. Methods Choose twenty patients undergoing elective esophagectomy were randomized to receive either combined general -epidural anesthesia with postoperative patient -controlled epidural analgesia（ PCEA, n = 10） or general anesthesia with postoperative patient - controlled intravenous analgesia（ PCIA, n = 10）. The stress response was quantitated by measuring of plasma norepinephrine, epinephrine, serum cortisol, adrenocorticotropin （ACTH）, interleukin （IL） -6, IL -10, and C -reactive protein （CRP） at pre -induction ,2 and 4 hours after incision, at the end of operation, and on the morning of postoperative days 1 （ POD1 ） and 3 （ POD3 ）. Results There were no changes in plasma norepinephrine and cortisol concentrations in GEA group but there were significant increases at the end of surgery and on POD1 （ P 〈 0.05 ） in GA group. Norepinephrine and cortisol levels restored to the baseline on POD3 in GA group. Epinephrine and IL - 10 levels remained unchanged in both groups. There were significant increases in serum ACTH, IL - 6 and CRP levels during and after the operation （ P 〈 0.05 ）, and there were no differences of serum ACTH, IL -6 and CRP levels between two groups. Conclusions Epidural blockade and PCEA could reduce the stress response to major thoracic surgery.