连续硬膜外阻滞与术后镇痛对上腹部手术应激激素变化的影响

摘要

目的 观察比较连续硬膜外腔阻滞与术后镇痛对上腹部手术应激激素的变化及其对应激反应的影响.方法 选择30例上腹部手术患者,随机分为膜外腔阻滞组(EA)和全身麻醉组(GA),每组各15例,分别测定麻醉诱导前、手术2 h、术毕、术后1 d及术后3 d的血浆去甲肾上腺素(NE)、肾上腺素(E)、血清促肾上腺皮质激素(ACTH)和皮质醇的水平.结果 血浆去甲肾上腺素和血清皮质醇EA组术中、术后无显著改变,但GA组术毕和术后1 d显著升高(P<0.05),术后3 d恢复至术前水平.两组血浆肾上腺素术中、术后均无显著变化.两组血清ACTH术中、术后均显著升高(P<0.05),组间比较差异无统计学意义(P>0.05).结论 连续硬膜外腔阻滞及术后镇痛可以减轻上腹部手术的应激反应.%Objective To observe and compare the effect of continuous epidural blockade and PCEA on the stress charge response to upper abdomen surgery. Methods Thirty patients undergoing upper abdomen surgery were randomized to receive either combined general anesthesia with postoperative patient-controlled epidural analgesia (PCEA) (EA group,n=15) or general anesthesia with postoperative patient-controlled intravenous analgesia (PCIA) (GA group,n=15). The stress response was quantitated by measuring of plasma norepinephrine, epinephrine, serum cortisol, adrenocorticotropin (ACTH),at pre-induction,2 hours after incision, at the end of operation,and on the morning of postoperative in the 1(POD1) and 3 (POD3) day. Results There were no changes in plasma norepinephrine and cortisol concentrations in GA group, but there were significant increases at the end of surgery and on POD1 in GA group (P<0.05). Norepinephrine and cortisol levels restored to the baseline on POD3 in GA group. Epinephrine levels remained unchanged in both groups. There were significant increases in serum ACTH levels during and after the operation (P<0.05), and there were no differences of serum ACTH between the two groups(P>0.05). Conclusions Continuous epidural blockade and PCEA could reduce the stress response toupper abdomen surgery.