脊柱侧弯矫形术不同麻醉方法的对比研究

Comparison of Different Anesthesia Methods Used in Scoliosis Surgery

选择脊柱侧弯手术病人３０例，观察单纯全麻（Ⅰ组）、全麻十控制性降压（Ⅱ）及连硬复合全麻（Ⅲ）三种不同麻醉法时血浆皮质醇、血糖及血流动力学变化。随机分三组，每组１０例，分别于术前、术始、术中刺激最强烈、拔管时及术后３ｈ抽中心静脉血测血浆皮质醇、血糖的浓度。结果表明：Ⅰ、Ⅱ组皮质醇、血糖和Ⅲ组血糖均在术中、拔管时和术后３ｈ明显升高，但Ⅲ组皮质醇与术前比较无明显变化（Ｐ＞０．０５），且Ⅲ组皮质醇、血糖在上述时间点较Ⅰ、Ⅱ组明显偏低（Ｐ＜０．０１）。提示，Ⅲ组较Ⅰ、Ⅱ组较有效抑制机体应激反应。此外，Ⅲ组血流动力学稳定、出血量少、拔管时间明显缩短、术后镇痛时间延长、是值得推广的一种麻醉方法。

The changes of plasma Cortisol, blood glucose and hemodynamics were observed in 30 patients undergoing scoliosis surgery. The patients ASA grade Ⅰto Ⅲ,were randomly divided into three groups:group I, general anesthesia(GA); group Ⅱ,general anesthesia with controlled hypotension (GA+CH)and group Ⅲ, general anesthesia combined with epidural blockade (GA+EA).The Central venous blood samples were taken before anesthesia, at the begining of operation, during operation, extubation and three hours after surgery.Plasma concentrations of cortisol and glucose were measured by radioimmunoassay.The plasma cortisol and sugar increased during operation,at and after extubation in group Ⅰand Ⅱ(P<0 01).Blood glucose was higher in group Ⅲ than that before anesthesia, but lower than that in group Ⅰand Ⅱ at the same time points. No change of cortisol concentrations was observed in group Ⅲ.There were stable circulation, small blood lose, short ertubation time, long postoperative analgesia in group Ⅲ. The combination of GA with EA is better to depress stress responses to anesthesia and scoliosis surgery than GA along or GA+CH.