摘要
目的探讨三种麻醉方法对老年高血压患者手术应激反应的影响。方法30例上腹部择期手术的老年高血压患者随机分为三组硬膜外阻滞组(Ⅰ组)、单纯全麻组(Ⅱ组)、硬膜外阻滞加全麻组(Ⅲ组)。测定麻醉诱导前、手术切皮前、手术1h、术毕、术后1d血清促肾上腺皮质激素(ACTH)、皮质醇、血管内皮素(ET)、C-反应蛋白(CRP)、白细胞介素-6(IL-6)、IL-8和肿瘤坏死因子α(TNF-α)水平。结果Ⅰ组和Ⅱ组患者的皮质醇、ACTH和ET在术毕及术后1d均显著高于诱导前(P<0.05);Ⅲ组患者变化不明显。三组患者的血浆TNF-α水平无显著性变化,IL-6、IL-8在手术1h、术毕均较诱导前显著升高(P<0.05),Ⅰ组、Ⅲ组升高较早,在手术开始时即已升高;而Ⅰ组、Ⅱ组持续时间长至术后1d。三组患者的CRP于术后1d均较诱导前显著升高(P<0.01)。结论单纯硬膜外阻滞或单纯全麻不足以减轻老年高血压患者上腹部手术过程中的应激反应,硬膜外加全麻则可明显减轻这些患者的应激反应。
Objective To compare the effect of three different anesthesia methods on the stress response in elderly hypertension patients undergoing upper abdominal surgery. Methods Thirty patients were randomly divided into three groups： epidural anesthesia alone（group Ⅰ）,general anesthesia alone（group Ⅱ ） and epidural anesthesia combined with general anesthesia（group Ⅲ）. Corticosteriods, ACTH and endotensin, TNF, IL-6,IL-8,C-reactive protein（CRP） were detected before induction（T0） ,incision（T1 ）, at 1h after incision（T2 ）,at end of operation（T3 ）, and on the 1st day after procedure（T4 ）. Results Compared with those at To, corticosteriods, ACTH and endotensin rose significantly in group Ⅰ and Ⅱ,group Ⅲ remained unchanged at T4. TNF remained unchanged in three groups. IL-6 and IL-8 rose significantly in three groups, but earlier at T1 in group Ⅰ and Ⅲ, and remained high at T4 in group Ⅰ and Ⅱ. CRP rose significantly at T4 in all three groups. Conclusion Either epidural anesthesia or general anesthesia alone cannot reduce the stress response during operation in elderly hypertension patients undergoing upper abdominal surgery. Epidural anesthesia combined with general anesthesia may significantly reduce the stress response to surgery.
出处
《临床麻醉学杂志》
CAS
CSCD
2006年第8期577-579,共3页
Journal of Clinical Anesthesiology
关键词
硬膜外麻醉
全身麻醉
应激
细胞因子
Epidural anesthesia
General anesthesia
Stress
Cytokinins
作者简介
责任作者：王红薇
