不同麻醉方法下行子宫切除时机体应激反应的比较

The comparation of the stress in hysterectomy with various method of anaesthesia

目的探讨行子宫切除时使机体应激反应最适度的一种麻醉方法。方法选30～60岁入我院拟施子宫全切(次全切)的患者,ASAⅠ～Ⅱ级,共60例,随机分配到四个组别:A组选硬膜外阻滞,B组选腰硬联合阻滞,C组选用异丙酚靶控输注插管全麻,D组选用全麻复合硬膜外阻滞。各组在麻醉前,麻醉后5min,切开腹膜时,切除子宫时,术毕五个时间点测下列指标:肾素、血管紧张素Ⅱ、醛固酮、皮质醇、胰岛素、血糖、生长素,同时监测患者的血流动力学指标。结果C组肾素活性、血糖于切开腹膜后各时点较麻醉前升高(P<0.05),胰岛素于切开腹膜后各时点较麻醉前降低(P<0.05)。皮质醇、生长素于切除子宫时增高(P<0.05)。结论四种麻醉方法均能抑制子宫切除引起的应激反应,尤以腰硬联合阻滞、全麻复合硬膜外阻滞为著,异丙酚靶控输注插管全麻虽能抑制气管内插管引起的应激反应,但不能完全抑制手术导致的肾素活性、皮质醇、血糖升高和胰岛素降低。

Objective To study the method of anaesthesia for the proper stress of pat ients with hysterectomy. Methods Choose aged 30-60 cases which were going to take cutting off womb, ASA Ⅰ- Ⅱ class, totally 60 example, these cases were divided into four groups randomly. The group A choosed the epidural block. The group B choosed combined spinal and epidural anaesthesia. The group C choosed endotracheal intubation genera 1 anaesthesia with target controlled infusion of propofol. The group D choosed general anaesthesia combined epidural block. Each group was taken blood sample before anaesthesia, after the anaesthesia 5 min, cutting open the peritoneum, cutting off the womb, the operat ion finished to determine the following signs; renin（PRA）, angiotensin Ⅱ （A Ⅱ ）, aldosterone（ALD）, corticosteroid（COR）, insulin（INS）, blood sugar（GLU）, growth hormone（GH）, while monitor ring hemodynamics. Results The level of rennin and blood sugar of group C goes up in cutting open the peritoneum and cutting off womb, shows the significant difference compared with the level before anaesthesia. The group C COR and GH is higher than the level before the anaesthesia in the excision womb, after pull outing the tube 5 min, and the leve 1 of group C is significantly different from the level of other groups, the group C the insulin goes down after cutting open the peritoneum more than the level before anaesthesia. Conclusions The four kinds of anaesthesia can all repress the stress of the patients with hysterectomy, particularly combined spinal and epidural anaesthesia and general anaesthesia combined epidural block, so can the epidural block. Though endotracheal intubation general anaesthesia with target controlled infusion of propofol can repress the stress from endotra cheal intubation, can＇t completely repress stress from surgical operation which lead to the droppin of INS and the rising of PRA, COR, GH, GLU.