全麻复合胸段硬膜外麻醉减轻上腹部手术后肠粘膜损伤

Thoracic epidural anesthesia combined with general anesthesia can reduce the intestine barrier dysfunction

目的探讨全麻复合胸段硬膜外麻醉(TEA)对上腹部手术后肠粘膜屏障功能的影响。方法上腹部手术患者随机均分为全麻+静脉镇痛(GA,n=10)组和全麻醉+胸段硬膜外麻醉+硬膜外镇痛(GE,n=10)组。术前(T1)、手术结束时(T2)、术后24 h(T3)和术后48 h(T4)取血测定血浆D-乳酸、内毒素(LPS)和全血肠细菌DNA(PCR法),并观察术后全身炎症反应综合症(SIRS)及感染并发症。结果两组T2、T3、T4血浆D-乳酸和LPS浓度>T1,且GA组>GE组(P<0.05)。术后细菌DNA检测阳性者GA组4例,GE组2例,差异有统计学意义(χ2=42.27,P<0.01)。术后24 h有SIRS表现者GA组6例,GE组4例,差异有统计学意义(χ2=37.64,P<0.01)。结论全麻复合TEA可减轻腹腔手术患者术后肠粘膜损伤。

Objective To investigate the effect of thoracic epidural anesthesia combined with general anesthesia on the intestine barrier function. Methods Twenty ASA class I-II patients undergoing elective upper abdominal surgeries were randomly divided into the general anesthesia group （group GA, n = 10） and the general anesthesia combined with thoracic epidural anesthesia （TEA）group （group GE, n = 10）. Both groups received phenobarbital sodium 0.1 g and atropine 0.5 mg im 30 min prior to the surgery. In the GE group an epidural catheter was inserted through a needle placed at T 8-9 or T9-10 and cephalad for 3.5 cm, and then 10 ml 0.5% bupivacarine was injected into the epidural spare after giving a tail dose of 3 ml 2% lidecarine. In both groups anesthesia was induced with 0.05 mg/kg midazolam, 3 μg/kg fentanyl, 0.1 mg/kg vecuronium and 0.15-0.25 mg/kg etomidate and maintained with inhalation of 1% -2.5 % isoflurance and inter-mitten iv boluses of fentanyl and vecuronium. After the operations, tramadol intravenous pump was given to the GA group and bupivacarine epidural pump was given to the GE group. The plasma D-lactate and Lip pelysaccharide （LPS） levels and the intestine microbial DNA were determined the day before the operation （T1） and 0 （T2）, 24 （T2） and 48 h（T4） after the operation by PCR. Results Plasma D-lactate and LPS were significantly increased at T2, T3, and T4 compared with T1 and were higher in group GA than in group GE （ P 〈 0.05）. Bacterial DNA was found in 4 patients in group GA and 2 patients in group GE （ X^2 = 42.27, P 〈 0.01 ）. Also SIRS was found in 6 patients in group GA and 4 patients in group GE during 24 h after surgeries （ X^2 = 37.64, P 〈 0.01 ）. Conclusion TEA combined with general anesthesia can reduce the intestine barrier dysfunction after upper abdominal surgery.