全麻联合胸段硬膜外阻滞对经胸手术患者炎症反应的影响

Effect of general anesthesia combined with thoracic epidural block on inflammatory response in patients undergoing thoracic surgery

目的比较单纯全麻和全麻联合胸段硬膜外阻滞对经胸手术患者围术期炎症反应的影响。方法选择40例经胸手术患者,ASAⅠ～Ⅱ级,随机分为两组(n=20),全麻联合硬膜外阻滞组(GEA组)和全身麻醉组(GA组)。T6～7椎间隙硬膜外穿刺置管,GEA组先硬膜外给于2%利卡多因5ml,调节麻醉阻滞平面达T3～10后,顺序静注咪达唑仑、芬太尼、依托咪酯、维库溴铵诱导,瑞芬太尼、丙泊酚、维库溴铵维持;GA组硬膜外注入与GEA组相同量生理盐水,静脉麻醉用药与GEA组相同。测定麻醉诱导前、切皮后3h、术后24h及术后48h血清IL-6和IL-10。结果与麻醉前比较,两组患者血清IL-6和IL-10浓度在切皮后3h、术后24h升高;与GA组比较,GEA组患者在术后24h血清IL-6浓度明显低于GA组(P<0.05),术后24h血清IL-10浓度明显高于GA组(P<0.05)。结论经胸手术患者,全麻联合硬膜外阻滞对手术刺激的炎症反应有较强的抑制作用。

Objective To evaluate the effect of general anesthesia combined with thoracic epidural block on perioperative inflammatory response in patients undergoing thoracic surgery. Methods Forty ASA I - II patients scheduled for thoracic surgery were randomly divided into two groups. The study group was performed with general anesthesia combined with thoracic epidural block （GEA group, n=20）, and the control group was performed with gen- eral anesthesia （group GA, n=20）. Patients in group GEA received 5 ml 2% lidoeaine via the epidurl route, and then were injected sequentially with midazolam, fentanyl, etomidate, vecuronium, remifentanil, propofol, vecuronium. Pa- tients in group GA received the same volume of saline via the epidurl route and the same anaesthetics. The levels of IL-6 and IL-10 were measured before induction of anesthesia, 3 h after skin incision, 24 h and 48 h after operation in the two groups. Results Compared with before anesthesia, the levels of IL-6 and IL-10 increased in patients at 3 h after skin incision and 24 h after operation. The level of serum IL-6 in group GEA was significantly lower than that in group GA 24 h after operation. The levels of serum IL-10 in group GEA was significantly higher than that in group GA 24 h after operation. Conclusion General anesthesia combined with thoracic epidural block can reduce perioperative stress response to thoracic surgery and has a better inhibitory effect on the inflammatory response.