全麻复合硬膜外阻滞麻醉对肝癌患者HIFU治疗围术期β-EP的影响

Influence of combined general-epidural anesthesia on beta-endorphin in patients with liver carcinoma undergoing HIFU treatment

目的:比较全身麻醉复合胸段硬膜外阻滞与单纯全麻对高强聚焦超声(HIFU)治疗肝癌患者围术期β-EP的影响。方法:将28例行HIFU治疗的肝癌患者随机分成A、B组,各14例。A组给予全麻复合胸段硬膜外阻滞麻醉,B组只给予全麻,麻醉诱导及维持用药两组基本相同。两组均于麻醉前(T0)、诱导后(T1)、HIFU治疗时(T2)、治疗后2h(T3)和治疗后24h(T4)采集静脉血检测血清内啡肽(β-EP)、皮质醇(Cor)和血糖(Glu),同时持续监测无创血压(SBP、DBP)、心率(HR)、直肠温度(RT)、苏醒质量和术后24h的VAS评分。结果:T0、T1,两组检测指标比较无显著性差异(P>0.05);T2,A组Cor和Glu水平较B组低(P<0.05或<0.01);T3,B组β-EP较T2和A组高(P<0.05),B组T4时点β-EP明显升高(P<0.01)。T0～T4,SBP、DBP和HR,A组较B组明显平稳。B组发生心律失常3例,苏醒期烦躁6例(P<0.01),A组无明显不良反应发生。B组RT最高值明显高于A组(P<0.01)。A组VAS评分较B组低(P<0.05)。结论:如同普通手术一样,HIFU治疗存在较强的以疼痛为主的应激反应,全身麻醉复合胸段硬膜外阻滞可以抑制肝癌患者HIFU治疗围术期β-EP和其他激素的分泌;术后早期PECA止痛适合HIFU治疗。

Objective： To compare the influence of general anesthesia combined with thoracic epidural anesthesia with general anesthesia alone on the perioperative β-EP in patients with liver cancer who had underwent High Intensity Focused Ultrasound （HIFU） treatment. Methods： Twenty-eight patients with liver cancer who had underwent HIFU treatment were divided randomly into average group A and B. Patients in group A underwent general anesthesia combined with thoracic epidural anesthesia, patients in group B underwent general anesthesia; medication for induction and maintenance of anesthesia was almost the same in the two groups. Peripheral venous blood was sampled before anesthesia （ TO ）, after anesthesia induction （ T1 ）, at the start of HIFU treatment （ T2）, 2h after HIFU treatment（ T3 ） and 24 h after HIFU treatment （T4） in both groups, and parameters including endorphin （β-EP）, cortisol （Cor） and glucose （Glu） in blood serum were determined respectively, ,at the same time continuous monitoring of nbn-invasive blood pressure （ SBP, DBP）, heart rate （ HR）, rectal, temperature （RT） and quality of consciousness recovery; severity of pain of 24 h after HIFU treatment was rated using a visual analog scale（VAS）. Results： Parameters between the two groups had no significant difference （P 〉 0. 05 ） at TO and T1 ; levels of Cor and Glu in group A were lower than the group B at T2 （P 〈0.05 or 〈0.01 ） ; level of β-EP in group B was higher than group A and that at T2 atT3 （ P 〈 0.05 ） ; level of β-EP in group B increased significantly at T4 （P〈0.01）. SBP, DBP and HR in group A were significant more stable than group B from TO to T4. Arrhythmias occurred in 3 cases in group B, and irritability occurred in 6 cases during consciousness recovery （P 〈 0. 01 ） ; no marked adverse events occurred in group A. The peak value of RT in group B was significantly higher than group A （P 〈0.01 ）. VAS score in group A was significantly lower than group B （P 〈0.05）. Conclusion： Stronger stress response of pain presents in patients with liver cancer who underwent HIFU treatment ; general anesthesia combined with thoracic epidural anesthesia can inhibit perioperative secretion of β-EP and other hormones in patients with liver cancer who underwent the HIFU treatment; early postoperative PCEA may relieve pain of patients with liver cancer who underwent HIFU treatment.