摘要
目的比较不同麻醉方法下行子宫切除时机体的应激反应,寻找较适度的一种麻醉方法。方法将60例30-60岁拟施子宫全切(次全切)、ASAⅠ-Ⅱ级的患者,随机区组设计分配到四个组:A组选硬膜外阻滞,B组选腰硬联合阻滞,C组选异丙酚靶控输注插管全麻,D组选全麻复合硬膜外阻滞。各组在麻醉前、麻醉后5min、切开腹膜时、切除子宫时、术毕五个时间点测肾素、血管紧张素Ⅱ、醛固酮、皮质醇、胰岛素、血糖、生长素,同时监测患者的血流动力学指标。结果A、B、D三组的肾素活性于麻醉后各时点下降,与麻醉前相比差异有统计学意义。C组肾素活性、血糖于切开腹膜后各时点较麻醉前升高(P<0.05),胰岛素于切开腹膜后各时点较麻醉前降低(P<0.05),皮质醇、生长素切除子宫时增高(P<0.05)。A、B、D三组的血压、心率于麻醉后各时点显著降低,而C组的血压、心率基本维持在麻醉前水平。结论四种麻醉方法均能抑制子宫切除引起的应激反应,尤以腰硬联合阻滞、全麻复合硬膜外阻滞为著,异丙酚靶控输注插管全麻虽能抑制气管内插管引起的应激反应,但不能完全抑制手术导致的肾素活性、皮质醇、血糖升高和胰岛素降低。
Objective To explore a better method of anesthesia for the proper stress of patients with hysterectomy. Methods Sixty ASA Ⅰ -Ⅱ patients with hysterectomy, aged 30 - 60 years, were divided into four groups randomly. The patients were given epidural block in group A, combined spinal and epidural anesthesia in group B, endotracheal intubation general anesthesia with target controlled infusion of propofol in group C, and general anesthesia combined epidural block in group D, respectively. Before anesthesia, after anesthesia for 5 min, at the time points of opening the peritoneum and cutting off the womb, and after operation, renin（PRA）, angiotensin Ⅱ （AⅡ）, aldosterone（ALD）, corticostemid（COR）, insulin（INS）, blood sugar（GLU）, growth hormone（GH） were deter- mined, and hemodynamies were monitored simultaneously. Results The levels of rennin in groups A, B, D decreased at other time points after anesthesia for 5 re.in compared with the level before anesthesia（ P 〈 0.05）. Compared with the level before anesthesia, the level of rennin and blood sugar in group C increased after opening the peritoneum（P〈0.05） ,but the level of insulin in group C decreased（ P〈 0.05 ）. The levels of CIDR and GH at the time point of cutting off womb in group C were higher than that before anesthesia（ P 〈 0.05 ）, and higher than in the other groups simultaneously. The blood pressure and heart rate in groups A, B, D dropped sharply after anesthesia for 5 min,but maintained the level before anesthesia in group C during operation. Conclusion The four methods of anesthesia can inhibit the stress of the patients with hysterectomy, particularly combined spinal and epidural anesthesia and general anesthesia combined epidural block. Anesthesia with endotracheal intubation and target controlled infusion of propofol can inhibit the stress induced by endotraeheal intubation, but can not completely repress the dropping of INS and the rising of PRA, COR, GH, GLU after operation.
出处
《山西医科大学学报》
CAS
2008年第10期941-945,共5页
Journal of Shanxi Medical University
关键词
硬膜外阻滞
腰硬联合阻滞
异丙酚靶控输注
全身麻醉
子宫切除
应激反应
epidural block
combined spinal and epidural anesthesia
target controlled infusion of propofol
general anesthesia
hysterectomy
stress
