兩種麻醉方法對開胸肺手術(shù)應(yīng)激反應(yīng)的影響

[摘要] 目的 觀察單純?nèi)榧叭閺?fù)合胸段硬膜外阻滯用于開胸肺手術(shù)的臨床效果。方法 將40例擇期行開胸肺手術(shù)患者隨機(jī)分為單純?nèi)椋℅A）組和全麻復(fù)合胸段硬膜外阻滯（GEA）組，每組20例。分別于麻醉前、插管后即刻、切皮時(shí)、切皮后30、60、120min及拔管后即刻測外周血中皮質(zhì)醇、腎上腺素和血糖濃度。結(jié)果 兩組術(shù)中血皮質(zhì)醇和血糖濃度均增高，切皮后2h達(dá)高峰，GEA組低于GA組（P＜0.05）。腎上腺素水平GA組明顯高于GEA組（P＜0.05）。MAP、HR于切皮后30min及60min GA組顯著升高，拔管時(shí)達(dá)高峰。同期GEA組波動(dòng)不明顯。結(jié)論 靜脈全麻復(fù)合胸段硬膜外阻滯能減輕開胸肺手術(shù)應(yīng)激反應(yīng)，且全麻藥用量減少，病人蘇醒早。

[關(guān)鍵詞] 硬膜外阻滯； 全身麻醉； 開胸術(shù)； 應(yīng)激

[中圖分類號] R614 [文獻(xiàn)標(biāo)識碼] A [文章編號] 1673-9701（2009）13-18-02

The Effect of Two Different Anesthesia Methods for Stress Response in Chest-open Lung Surgery

ZHOU Yuelan1 YANG Luzong2

1.Department of Anesthesiology，Thoracic Hospital of Hunan Province，Changsha 410013；2.Department of Anesthesiology，Longhua Hospital of Shanghai，Shanghai 200433

[Abstract] ObjectiveTo observe the clinical effect of general anesthesia（GA） and combined general-epidural block anesthesia（GEA） in chest-open lung surgery. MethodsForty patients were divided into two groups：Group GA and Group GEA. Each one has 20 cases. The concentration of cortisol（Cor），Adrenaline（E），Blood sugar（Glu）in peripheral blood were measured at the time before induction of anesthesia，intubation，incision，and 30min，60min，2 hour after incision，and extubation. ResultsThe concentration of Cor and Glu were both increased during operation，and reached the peak at 2 hours after incision，while the increasing level of group GEA was lower than that of group GA（P < 0.05）. MAP and HR were increased significantly 30min and 60 min after incision in group GA，reached it peak when extubation. The fluctuation in group GEA was not so significant. ConclusionThe stress response in combined general-epidural block anesthesia was lighter. It could also spend less anesthesia drugs in GEA group，made patients recovery sooner.

[Key Words]Epidural block； General anesthesia； Thoracic surgery； Stress response

任何手術(shù)創(chuàng)傷均可導(dǎo)致機(jī)體應(yīng)激反應(yīng)，其中交感-腎上腺系統(tǒng)尤為活躍。用一定的藥物或麻醉技術(shù)可預(yù)防或減輕手術(shù)應(yīng)激反應(yīng)，降低高代謝狀態(tài)，減少術(shù)后并發(fā)癥[1]。本研究觀察比較單純?nèi)楹腿閺?fù)合硬膜外阻滯用于開胸肺手術(shù)術(shù)中循環(huán)指標(biāo)，皮質(zhì)醇（Cor）、腎上腺素（E）和血糖（Glu）濃度的變化。

1 資料與方法

1.1 一般資料

選擇2007年2月～2008年2月40例行擇期開胸肺手術(shù)患者，男27例，女13例。年齡17～72歲，體重33～80kg，ASAⅠ～Ⅲ級，隨機(jī)分為單純?nèi)椋℅A）組及全麻復(fù)合胸段硬膜外阻滯（GEA）組，每組20例。所有病人術(shù)前均無免疫及神經(jīng)內(nèi)分泌系統(tǒng)疾病，未服用激素類藥物。兩組年齡、性別、體重、手術(shù)時(shí)間、失血量、補(bǔ)液量及輸血量無顯著差異（P＞0.05）。

1.2 麻醉方法

于麻醉前30min肌注阿托品0.5mg、苯巴比妥鈉0.1g，入室后開通外周靜脈，靜脈注射咪唑安定0.05mg/kg。……