硬膜外复合全麻与全静脉麻醉对上腹部手术后炎症反应及肠道细菌移位的比较

摘要

目的 研究硬膜外复合全身麻醉与全静脉麻醉对上腹部手术术后炎症反应及肠道细菌移位的影响.方法 择期上腹部手术患者60例,ASAⅠ～Ⅱ级,随机分为2组.A组,诱导后采用硬膜外阻滞复合丙泊酚维持全身麻醉;B组,诱导后采用静脉丙泊酚+瑞芬太尼维持全身麻醉.术中收缩压高于160mmHg或大于基础值20%时采用硝酸甘油降压.在术后1、2d采集外周血,ELISA法检测肿瘤坏死因子(tumor necrosis factor-α,TNF-α)、白细胞介素-10(interleukin-10,IL-10)反映炎症水平;细菌基因组提取全血细菌DNA反映肠道细菌移位.结果 A组术后第1天及术后第2天TNF-α、IL-10显著低于B组(P＜0.05);A组全血细菌DNA显著低于B组(P＜0 05).结论 硬膜外阻滞复合全麻较全静脉麻醉可显著降低术后炎症反应,减少肠道细菌移位.%Objective To compare postoperative inflammation and bacterial translocation under combining epidural blockade with general anesthesia and total intravenous anesthesia after upper abdominal surgery. Methods Sixty ASA grade I ～ II , aging 23 ～ 65 years patients undergoing selective operation were randomly divided into group A and group B. Group A, anesthesia was maintained with epidural block combining with intravenous propofol flowing induction of general anesthesia; and in group B, anesthesia was maintained with intravenous propofol and remifentanyl. Nitroglycerin was administrated when systolic blood pressure ( SBP ) was greater than 160mmHg or greater than 20% of baseline during operation. Tumor necrosis factor - α( TNF - a ), interleukin -10(IL-10) in peripheral blood were detected by ELISA assay; also bacterial DNA were extracted in whole blood to reflect bacterial translocation at the first day and second day after operation. Results TNF - a and IL - 10 were significantly lower in group A than group B ( P < 0. 05 ) on postoperative first and second day; and bacterial DNA in whole blood was significantly lower in group A than group B ( P < 0. 05 ) at the same time. Conclusion Compared with total intravenous anesthesia epidural block can significantly reduce the postoperative inflammatory response and bacterial translocation.