全麻复合右美托咪定或硬膜外阻滞对胸部手术应激反应的影响

Influence of general anesthesia combining with dexmedetomidine or epidural anesthesia on stress response of thoracic surgery

目的：比较全麻复合右关托咪定与全麻复合硬膜外阻滞对胸科手术患者应激反应的影响。方法：选择72例ASAⅠ-Ⅱ级择期胸科手术病人，随机分为3组，分别为Ⅰ组（全麻复合右美托咪定）、Ⅱ组（全麻复合硬膜外阻滞）和Ⅲ组（单纯全麻组，即对照组），每组各24例，在入室后即刻（T1）、气管插管后即刻（T2）、进胸探查时（T3）、关胸时（T4）分别监测患者MAP、心率（HR）、血氧饱和度（SpO2）、空腹血糖（GLU）及皮质醇（Cor）水平。结果：与T1相比，T2-T4时Ⅲ组在MAP、HR及Cor明显升高，差异具有统计学意义（P〈0．01）；从T2时间点开始，Ⅰ、Ⅱ组与Ⅲ组相比，Cor水平明显降低，差异具有统计学意义（P〈0．01）；T2时间点Ⅰ组Cor水平相对Ⅱ组明显降低，差异具有统计学意义（P〈0．01）。结论：全麻复合右关托咪定可降低患者应激反应，其程度与全麻复合硬膜外阻滞相当，且在维持血流动力学方面前者优于后者。

Objective= To compare the influence of anesthesia combined with dexmedetomidine or epidural anesthesia on stress response of thoracic surgery. Methods： A total of 72 patients undergoing elective thoracic surgery of ASA Ⅰ - Ⅱ were randomly divided into 3 groups with 24 cases in each group. Group I was given general anesthesia combined with dexmedeto- midine, group Ⅱ was given general anesthesia combined with epidural anesthesia, and group Ⅲ was given simple general anes- thesia. MAP, HR, SpO2, GLU and Cor were recorded and at following time points= when patients entered the operating room （T1）, immediately after intubation （T2）, probing into the chest （T3） and after chest was close （T4）. Results In all three groups, MAP, HR and Cot were significantly higher at T2-4 than that at T1 （P〈0.01）. Started from T2, Cor level of group Ⅰand Ⅱ were significantly decreased comparing with that in group Ⅱ （P〈0.01）, and Cor level of group Ⅰ was significantly decreased than that of group Ⅲ （P〈0.01）. Conclusions： General anesthesia combining with dexmedetomidine can reduce the stress response of thoracic surgery, which is comparable to general anesthesia combing with epidural anesthesia.