不同麻醉方法对围手术期应激反应的影响

THE EFFECT OF DIFFERENT ANESTHESIA METHODS ON REACTIONTO STIMULATE OF PERIOPERATION PERIOD

目的 :探讨上腹部手术中三种不同麻醉方法对应激反应的影响。方法 :30例择期上腹部手术病人分为三组 :静脉复合全麻组 (Ⅰ组 ) ,静脉吸入复合全麻组 (Ⅱ组 )、静脉全麻复合硬膜外阻滞 (Ⅲ组 )。测定麻醉前 (T0 )、手术开始后 60min(T1)、手术后 2 4h(T2 )、手术后 4 8h(T3)、手术后 72h(T4 )血清免疫球蛋白 (lgG、lgA、lgM)、胰岛素 (INS)和血糖 (GLU)浓度 ,同时连续监测SBP、DBP、MAP、HR的变化。结果 Ⅰ、Ⅱ组lgG、lgA、lgM浓度显著升高 (p <0 .0 1) ,Ⅲ组lgG、lgA、lgM浓度显著降低 (p <0 .0 1) ,Ⅲ组GLU、INS各个时相与麻醉前相比变化幅度小 ,且手术后 72h基本恢复达到麻醉前水平 ;GLU浓度变化平稳 ,变化幅度比Ⅰ组低 5 8个百分点 ,INS值Ⅰ、Ⅱ组手术后 72h仍处在高值上 ,Ⅱ组是麻醉前的 3.6倍。本组试验组间比较 ,Ⅲ组静脉全麻复合硬外阻滞组 ,其lgG、lgA、lgM、INS和GLU的浓度变化明显小于Ⅰ组 (p <0 .0 1) ,三组患者lgG、lgA、lgM、INS和GLU浓度与SBP、DBP、MAP、HR无相关性。结论 :静脉全麻复合硬膜外阻滞麻醉方法用于上腹部手术 ,对血清免疫球蛋白 (lgG、lgA、lgM)、胰岛素 (INS)和血糖 (GLU)浓度的影响最小。控制术中应激反应效果显著 ,机体恢复较快 ,明显优于静脉复合全麻和静脉吸入复合全?

Objective:To investigate the effect of three different anesthesia methods applied to upper abdominal surgeries on reaction to stimulate.Methods:Thirty cases of upper abdominal surgeries were randomly divided into three groups: intravenous balanced general (groupⅠ) intravenous inhalation balanced general anesthesia(groupⅡ), intravenous general anesthesia balanced epidural block(groupⅢ).The concentrations of lgG,lgA,lgM,insulin(INS) and glucose(GLU) were measured at five different time which is before anesthesia induction(T 0),60 minutes after operation (T 1),24 hours after operation(T 2),48hours after operation(T 3) and 72hours after operation (T 4).Simultaneously,the changes of SBP,DBP,MAP and HR were adminstrated continually.Results:The concentrations of lgG,lgA and lgM climbed up strongly in group Ⅰ and group Ⅱ(p<0.01),but those in group Ⅲdropped down heavily(p<0.01).The concentrations of GLU and INS in group Ⅲ changed little after operation contrast to before anesthesia induction and nearly returnde to the level of before anesthesia induction at 72 hours after operation .The changing range of GLU in group Ⅲ was 58 per cent less narrow than that in groupⅠ.The concentrations of INS of group Ⅰ and group Ⅱremained high at 72 hours after operation and that of group Ⅱat 72 hours after operation was as 3.6 times high as before anestesia induction.The concentrations of lgG,lgA,lgM,INS and GLU in group I had an obviously bigger change than those in group Ⅲ(P<0.01).The concentrations of lgG,lgA,lgM,INS and GLU didn't correlate with SBP,DBP,MAP and HR in all groups.Conclusion:Among the three different methods,intravenous general anesthesia balanced epidural block is better than other two methods,because it has least effect on the concentrations of lgG,lgA,lgM,INS and GLU and its capability of controlling reaction to stimulate enables patients to recover soon.