全麻并胸段硬膜外阻滞开胸手术患者血糖、胰岛素、血皮质醇的水平

Effect of the combined general-thoracic-epidural-anesthesia on blood glucose, insulin and cortisone in patient undergoing thoracotomy

目的 通过检测单纯全麻或全麻并胸段硬膜阻滞开胸手术患者的血糖、血清皮质醇、胰岛素浓度及观察血流动力学的变化 ,比较两种麻醉方法对抑制手术时应激反应的差异 .方法 将 2 0例 ASA ～ 级开胸手术患者随机分为两组(n=10 ) :G组按照常规方法诱导后进行气管内插管全麻 ,术中静吸复合维持麻醉 ;G+C组先行胸 6～ 7椎间隙硬膜外穿刺置管后再行气管内插管全麻 ,在静吸复合全麻的同时硬膜外腔给予 3.75 g· L- 1 布比卡因 .分别在麻醉前、切皮后 10min、胸腔探查 ,关胸时 4个时间点记录血流动力学变化并采静脉血测定血清皮质醇、胰岛素、血糖纪录 .结果 G组皮质醇在切皮 2 5 1.4± 18.2 ,探查 2 6 0 .5± 139.7及关胸时 2 71.6± 133.3均高于 G+C组 182 .6± 83.5 ,188.6± 10 3.3和2 6 3.0± 86 .9(P<0 .0 5 ) ;胰岛素仅在关胸时 G组 18.1± 13.7高于 G+C组 12 .6± 4 .6 (P<0 .0 5 ) ;血糖值 G组在胸腔探查6 .7± 0 .8,关胸时 8.8± 1.1比 G+C组 6 .5± 1.2及 8.0±1.1高 (P<0 .0 5 ) ;SBP G组切皮时 17.1± 1.4、探查时 16 .4±2 .5比 G+C组同一时点 14 .8± 2 .1及 12 .9± 1.8高 (P<0 .0 5 ) .结论 开胸手术时使用全麻加硬膜外阻滞能有效的抑制手术引起的应激反应 ,使患者在术中更为安全平稳 ,麻?

AIM To compare the stress responses to thoraco tomy under general anesthesia and combined general epidural anesthesia. METHODS Twenty ASAⅠ~Ⅱ patients undergoing elective thoracotomy were randomly divided into two groups ( n =10): Group G (general anesthesia) and Group G+C (combined general epidural anesthesia). Group G received combined inhale intravenous anesthesia only during the operation. Group G+C received combined inhale intravenous anesthesia and at the same time 3.75 g·L -1 bupicaine was given through thoracic epidural cavity during the operation. Plasma concentrations of cortisone, insulin, glucose and hemodynamics were measured before the anesthesia, 10 min after the incision, and when the thoracic cavity was explored and closed. RESULTS Cortisones were higher significantly in Group G than those in Group G+C 10 min after the incision, exploration and closing thoracic cavity (251.4±18.2 vs 182.6±83.5, 260.5±139.7 vs 188.6±103.3, 271.6 ± 133.3 vs 263.0±86.9) ( P <0.05). Insulin was higher in Group G (18.1±13.7) than that in Group G+C (12.6± 4.6 ) ( P <0.05) at closing thoracic cavity. Glucoses were higher in Group G (6.7±0.8, 8.8±1.1) than those in Group G+C (6.5±1.2, 8.0±1.1) at exploration and closing thoracic cavity ( P <0.05). SBPs were higher in Group G ( 17.1 ±1.4, 16.4±2.5) than that in Group G+C (14.8±2.1, 12.9±1.8) 10 min after the incision, exploration thoracic cavity ( P <0.05). CONCLUSION Combined general epidural anesthesia can effectively attenuate stress response to thoracotomy.