不同麻醉方式对患者术中应激反应的影响

Influence of different anesthesia on patients undergoing the stress response

目的:探讨全麻复合硬膜外阻滞(GEA)和单纯全麻(GA)对患者术中应激反应的影响。方法:本文分别采用GEA和GA对上腹部手术患者进行临床麻醉,并比较两种麻醉方式对患者术中应激反应的影响。结果:两组患者的血浆皮质醇(Cor)、血管紧张素-Ⅱ(A-Ⅱ)、β-内啡肽(β-EP)及白细胞介素-10(IL-10)等监测指标均随着麻醉的进行呈现上升趋势,而在拔管时两组患者的Cor均高于麻醉前(P<0.05);在切皮时、切皮后1h,GA组明显高于GEA组(P<0.05)。GEA组拔管时的A-Ⅱ明显高于麻醉前,且差异有统计学意义(P<0.05);GA组切皮后1h、拔管时均较麻醉前升高(P<0.05)。两组患者β-EP术中、拔管时均上升,与麻醉前GA组相比明显升高(P<0.05)。两组患者的IL-10术中、拔管时均呈上升趋势,但GEA组患者拔管时的IL-10水平明显高于GA组(P<0.05)。GEA组的血压、心率在切皮时和切皮后1h均明显小于麻醉前(P<0.05);而GEA组血压、心率在切皮时和切皮后1h均明显低于GA组(P<0.05)。结论:全麻复合硬膜外阻滞与单纯全麻相比,可以减轻但并不能完全抑制上腹部手术围术期的应激反应,是一种很好的麻醉方法。

Objective： To investigate the influence of general anesthesia combined with epidural anesthesia （GEA） and a simple general anesthesia （GA） on patients undergoing the stress response. Methods： GEA and GA were used for upper abdominal surgery in patients with clinical anesthesia, and the two methods of anesthesia on patients undergoing the stress response were compared. Results： Plasma cortisol （Cor）, angiotensin-Ⅱ （A-Ⅱ）, β-endorphin （β-EP）, interleukin-10 （IL-10） of the two groups were along with the upward trend, but after extubation Cor were higher than before anesthesia （P0.05）. In the skin incision, after incision 1 h, GA group was significantly higher than the GEA group （P0.05）. After extubation, A-Ⅱ of GEA group was significantly higher than pre-anesthesia, and the difference was statistically significant （P0.05）. 1 h after incision, GA group when compared with anesthesia before extubation increased （P0.05）. Two groups of patients with β-EP surgery, extubation were up, compared with the GA group before anesthesia, which was significantly higher （P0.05）. Two groups of IL-10 intraoperative, extubation were on the rise, but the GEA group of patients with extubation of IL-10 levels were significantly higher than the GA group （P0.05）. GEA group, blood pressure, heart rate during and after incision in the skin incision were significantly less than 1 h before anesthesia （P0.05）; and GEA blood pressure, heart rate during and after 1 h incision in the skin incision were significantly lower than GA Group （P0.05）. Conclusion： General anesthesia combined with epidural anesthesia compared with the simple, the stress response can be reduced but not completely inhibited, and it is a good method of anesthesia.