胸段硬膜外阻滞复合全麻辅以术后自控硬膜外镇痛对食管癌手术患者应激反应的影响

Effect of thoracic epidural anesthesia combined with total intravenous general anesthesia and postoperative patient controlled epidural analgesia on stress reaction in patients undergoing thoracic surgery for esophagus cancer

目的探讨胸段硬膜外阻滞复合全麻、术后辅以患者自控硬膜外镇痛对食管癌开胸手术患者应激反应的影响。方法 60例拟行食管癌开胸手术患者分为观察组和对照组各30例,对照组采用全凭静脉麻醉,术后给予患者自控硬膜外镇痛;观察组采用胸段硬膜外阻滞复合全麻、术后辅以患者自控硬膜外镇痛。分别于麻醉诱导前30 min(T0)、切皮后5 min(T1)、术后1 h(T2)、术后12 h(T3)、术后24 h(T4)测定患者血清皮质醇(Cor)、催乳素(PRL)和白细胞介素-6(IL-6)的含量。结果观察组T2～T3时间点的Cor水平与T0比较差异有统计学意义(F=9.126,P<0.05);观察组T4时间点的Cor水平基本达到基线水平,与T0时间点比较差异无统计学意义(t=2.711,P>0.05)。观察组T1～T4时间点PRL水平与T0比较差异有统计学意义(F=10.823,P<0.05);观察组T4时间点PRL水平基本达到基线水平,与T0时间点PRL水平比较差异无统计学意义(t=2.820,P>0.05)。观察组在T1～T4的IL-6水平与T0、对照组比较差异均有统计学意义(F=9.882;t=9.842、11.321、13.095、15.494,P<0.05)。结论胸段硬膜外阻滞复合全麻、术后辅以患者自控硬膜外镇痛能有效降低食管癌开胸手术患者围手术期的应激反应。

Objective To evaluate the effect of thoracic epidural anesthesia （TEA） combined with total intravenous general anesthesia （TIVA） and postoperative patient controlled epidural analgesia （PCEA） on stress reaction in patients undergoing thoracic surgery for esophagus cancer. Methods Sixty cases of patient proposed thoracic surgery were divided into observation group and control group. The control group was given the TIVA and postoperative PCEA, and the observation group was given the TEA combined with TIVA and postoperative PCEA. Before induction of 30 min （T0）, after incision 5 min （T1）, postoperative lh （T2）, postoperative 12 h （T3） and postoperative 24 h （T4）, the serum cortisol （Cor）, prolactin （PRL） and interleukin-6 （IL-6） levels were detected. Results The Cor level of observation group at T2 - T3 comparing with the T0, the difference was significant （F = 9.126, P 〈 0.05）; The Cor level of observation group at T4 achieved the baseline level, comparing with To the difference was not significant （t = 2.711, P 〉 0.05）. The PRL level of observation group at T1 - T4 com- paring with the To, the difference was significant （F = 10.823, P 〈 0.05）; The PRL level of observation group at T4 achieved the baseline level, comparing with To the difference was not significant （t = 2.820, P 〉 0.05）. The IL-6 level of observation group at TI-T4 comparing with the To and control group, the differences were significant （F = 9.882; t = 9.842, 11.321, 13.095, 15.494, P 〈 0.05）. Conclusion The thoracic epidural anesthesia combined with total intravenous general anesthesia and postoperative patient controlled epidural analgesia can reduce the stress reaction in patients undergoing thoracic surgery for esophagus cancer.