硬膜外麻醉可减轻无气腹腹腔镜妇科手术应激反应

Effects of anesthestic techniques on stress response to gynecological laparoscopic operation without pneumoperitoneum

目的:比较在不同麻醉方法下行无气腹腹腔镜妇科手术对血糖、胰岛素、皮质醇及TNF-α的影响。方法:选择38例择期行妇科腹腔镜手术,并根据美国麻醉医师协会(ASA)标准确定为Ⅰ～Ⅱ级的患者,随机分成2组,每组19例。Ⅰ组,于静脉全麻下行无气腹腹腔镜手术;Ⅱ组,于硬膜外麻醉下行无气腹腹腔镜手术。监测2组患者麻醉前(T1)、气腹或悬吊建立后30min(T2)、气腹或悬吊撤除后10min(T3)和术后第2天晨8时(T4)4个时点的血糖、胰岛素、皮质醇、和TNF-α浓度。结果:麻醉前患者的血糖、胰岛素、皮质醇和TNF-α水平无明显差别(P>0.05),术后各水平均逐渐升高。组间比较,Ⅰ组在T3时点的血糖、胰岛素水平和TNF-α高于Ⅱ组(P<0.05);Ⅰ组的血皮质醇水平在T3和T4时点均高于Ⅱ组(P<0.01和P<0.05)。结论:与全麻比较,硬膜外麻醉可减弱无气腹腹腔镜妇科手术的应激反应。

Objective：To study the changes of serum blood glucose,insulin,cortisol and TNF-α in patients underwent gynecological laparoscopic operations using abdominal wall-lifting methods under different anesthesia. Methods：Thirty-eight patients scheduled for gynecological laparoscopy,ASA Ⅰ - Ⅱ ,were randomly divided into two groups （Ⅰ , Ⅱ ） with 19 cases in each group respectively. Patients of group Ⅰ were operated under general anesthesia and gasless technique. Patients of group Ⅱ went through the same operative procedures under epidural anesthesia and gasless technique. All patients were monitored including blood glucose,insulin, cortisol,TNF-α at four time points：before anesthesia （T1）, at 30 rain after the operations beginning （T2） and 10 min after the end of the surgery （T3） and at 8 AM in the next morning （T4）. Results：There were no obvious differences in blood glucose,insulin,cortisol and TNF-α between the two groups at T1（P 〉 0.05） ,and these values increased after the beginning of the operations, reaching their peak values at T4. The levels of blood glucose, insulin and TNF-α were higher in group Ⅰ than those in group Ⅱ at T3 （P 〈 0.05）. Levels of serum cortisol were higher in group Ⅰ than those in group Ⅱ at T3（P 〈0.01）and T4（P 〈 0.05）. Conclusion： Compared with general anesthesia, epidural anesthesia might reduce stress responses in patients underwent gynecological gasless laparoscopic operation.