全麻复合硬膜外麻醉对腹腔镜子宫切除术患者应激反应与纤溶功能的影响

Effects of Laparoscopic Hysterectomy on Stress Response and Fibrinolysis Function of Patients with General Anesthesia Combined with Epidural Anesthesia

目的:比较单纯全麻与全麻复合硬膜外阻滞对妇科腹腔镜手术患者应激反应和纤溶功能的影响。方法:76例腹腔镜下行子宫切除手术的患者随机分为A组(单纯全麻)和B组(全麻复合硬膜外阻滞),每组38人。分别于麻醉前(T0)、术毕(T1)、术后12h(T2)和48h(T3)采集静脉血,测定血浆去甲肾上腺素(NA)、肾上腺素(AD)和D-二聚体(DD)、组织型纤溶酶原激活物(t-PA)和纤溶酶原激活物抑制物(PAI-1)浓度。结果:与A组相比,B组T1-T3应激反应指标NA和AD值分别下降,两组差异有统计学意义;与T0相比,两组T1-T3时DD均升高,两组t-PA值T1-T2时均升高;B组T3时t-PA值下降,与麻醉前或与A组同时期相比,差异均有统计学意义;B组PAI-1在T1-T3低于A组。结论:全麻联合硬膜外阻滞有利于抑制腹腔镜手术中的应激反应和抑制PAI-1活性的升高,是腹腔镜手术较为理想的麻醉方法。

Objective：To observe the changes of stress response and fibrinolysis function in patients undergoing laparoscopic hysterectomy with general anesthesia combined with epidural anesthesia or with simple general anesthesia.Methods：Seventy-six patients undergoing laparoscopic hysterectomy were randomly divided into group A（general anesthesia） and group B（general anesthesia combined with epidural block）,with 38 cases in each group.Serum samples were collected to measure plasma norepinephrine（NA）,adrenaline（AD）,D-dimer（DD）,tissue plasminogen activator（t-PA）,and plasminogen activator inhibitor（PAI-1） concentrations before anesthesia（T0）,at the end of operation（T1）,and at the 12th（T2） and 48th hours（T3） after operation.Results：Compared with those in group A,stress response parameters NA and AD values during T1-T3 in group B decreased significantly;compared with those at T0,DD value at T1-T3 increased in both groups.The t-PA value in both two groups increased after anethesia,but decreased in group B at T3,the PAI-1 value in the group B at T1-T3 decreased significantly as compared with that respectively in group A.Conclusion：General anesthesia combined with epidural block can suppress the stress response in patients undergoing laparoscopic surgery,inhibit PAI-1 activity,and is an ideal method of anesthesia in laparoscopic surgery.