脊麻药液中加微量吗啡对剖宫产病人应激反应的影响

Effects of spinal anesthesia with bupivacaine and morphine on stress response in patients undergoing Cesarean section

目的探讨脊麻药液中加入微量吗啡对剖宫产病人应激反应的影响。方法30例择期剖宫产病人随机分成两组:Ⅰ组,20例,脊麻用药为0.75%布比卡因1.8ml+吗啡0.2mg;Ⅱ组,10例,脊麻用药为0.75%布比卡因1.8ml。分别于麻醉前(T0)、术后即时(T1)、24h(T2)、72h(T3)采集外周静脉血,测定促肾上腺皮质激素(ACTH)、β-内啡肽(β-EP)、血管紧张素-Ⅱ(A-Ⅱ)、醛固酮(Ald)、皮质醇(Cor)和胰高血糖素(GC)水平。结果Ⅱ组T3的ACTH水平显著低于T0(P<0.05)。Ⅰ组T2的β-End水平显著低于Ⅱ组(P<0.05)。Ⅰ组T2、T3的A-Ⅱ水平显著低于T0(P<0.01)。Ⅰ组T1、T2、T3的Ald水平显著低于T0(P<0.01),Ⅱ组T3的Ald水平显著低于T0(P<0.05)。两组T2、T3的Cor水平均显著低于T0(P<0.01或P<0.05)。Ⅰ组T1、T2和T3的GC水平显著低于T0(P<0.05或P<0.01)。Ⅱ组T3的GC水平显著低于T0(P<0.01)。结论脊麻药液中加入微量吗啡可减轻剖宫产病人的应激反应。

Objective To study the effects of spinal anesthesia with bupivacaine and morphine on stress response in patients undergoing Cesarean section. Methods Thrity selective Cesarean section patients were randomly divided into two groups. Twenty patients in group A were given 0. 75% bupivacaine 1.8 ml plus morphine 0.2 mg for spinal block,and ten patients in group B 0. 75% bupivacaine 1.8 ml only as the controls. Peripheral venous blood samples were taken for detecting the levels of ACTH, aldosterone （Ald）, β-endophine （ β-EP）, glucagon （GC）, angiotensin- Ⅱ （ A- Ⅱ ）, and cortisone（Cor） before anesthesia （T0）, at the end of surgery （T1）, 24 （T2） and 48 h （T3） after operation. Results Blood level of ACTH was significantly lower at T3 than that at TO in group B （P〈0.05）. Blood level of β-EP at T2 was significantly lower in group A than that in group B （P〈0. 05）. Blood level of A-Ⅱ was significantly lower at T2,T3 than that at TO in group A （P〈0. 01）. Blood level of Ald was significantly lower at T1,T2,T3 than that at TO in group A （P〈0. 01） ,so did that at T1 in group B （P〈0. 05）. Blood level of Cor was significantly lower at T2,T3 than that at TO in both groups （P〈0.01 or P〈0. 05）. Blood level of GC was significantly lower at T1,T2,T3 than that at TO in group A, so did that at T3 in group B （P〈0. 01）. Conclusion Stress response in patients undergoing Cesarean section may be attenuated by adding small dose of morphine into local anesthetic soluton for spinal anesthesia.