摘要
目的 观察硬膜外阻滞联合全麻对异氟醚用量及皮质醇、生长激素、IL-6和IL-8的影响。方法40例择期胃肠手术病人,随机分为全麻-静脉利多卡因组(A组,n=10),全麻-静脉生理盐水组(B组,n=10),全麻-硬膜外利多卡因-静脉生理盐水组(C组,n=10),全麻-硬膜外生理盐水-静脉生理盐水组(D组,n=10)。所有病人均于诱导后开始试验。A组先静脉内注射2％利多卡因1mg·kg^(-1)负荷量,以后静脉持续输注25μg·kg^(-1)·min^(-1)维持;B组静脉内注射与A组利多卡因相同容量的生理盐水;C组插管前硬膜外注射2％利多卡因15 ml,插管后静脉输注与B组等容量的生理盐水维持;D组插管前硬膜外注射生理盐水15 ml,插管后静脉内输注与B组相同容量的生理盐水维持。四组均同时吸入异氟醚10min并调整吸入浓度,当脑电双频谱指数(BIS)稳定在50左右时,监测听觉诱发电位(AEP),记录呼气末异氟醚浓度,采桡动脉血测血浆利多卡因浓度。C、D组则分别在诱导前(T1)、切皮后即刻(T2)、切皮后2 h(T3)和切皮后4 h(T4)测定外周血皮质醇、生长激素、IL-6和IL-8浓度。结果 C组的异氟醚浓度明显低于A、B、D组(P<0.05),A组和C组利多卡因血药浓度差异无显著性(P>0.05)。C组AEP明显高于A、B、D组(P<0.05)。C组皮质醇、生长激素及IL-8浓度在T2、T3。
Objective To investigate the effects of epidural block on isoflurane requirement for general anesthesia and plasma levels of cortisol, growth hormone (GH), interleukin- 6 and -8 (IL-6, IL-8) in response to surgical stress. Methods Forty ASA Ⅰ - Ⅱ patients (18 male, 22 female) aged 20-60 yr undergoing elective gastro-intestinal surgery were randomly divided into 4 groups of 10 patients : group A received general anesthesia + intravenous( i. v. ) lidocaine; group B general anesthesia + i. v. normal saline (NS); group C general anesthesia + epidural lidocaine + i. v. NS and group D general anesthesia + epidural NS + i. v. NS. Radial artery was cannulated for direct BP monitoring. ECG, BIS, AEP, SpO2 and end-tidal isoflurane concentration were monitored during anesthesia. Anesthesia was induced with fentanyl 4 μg·kg-1 and thiopental 5 mg·kg-1 . Tracheal intubation was facilitated with succinylcholine 2 mg·kg-1 . Anesthesia was maintained with isoflurane inhalation, and BIS was maintained at around 50. In group A a loading dose of 2 % lidocaine 1 mg · kg-1 was given i. v. followed by i. v. infusion of lidocaine at 25 μg · kg-1 · min-1 . In group B i. v. lidocaine was replaced by equal volume of normal saline. In group C and D an epidural catheter was inserted at T9-10 or T10-11, and advanced 3-4 cm in a cephalad direction. In group C a loading dose of epidural 2% lidocaine 3 ml was given and 5 min later when correct placement of the catheter in the epidural space was confirmed and sensory block was identified, another dose of 2% lidocaine 12 ml was given via epidural catheter. In group D epidural lidocaine was replaced by epidural normal saline. In group A and C plasma lidocaine concentrations were measured at 5, 10, 15 and 20 min after the loading dose of i. v. or epidural lidocaine. In group C and D blood samples were taken before induction of anesthesia (T1 , baseline), immediately (T2), 2 h (T3 ) and 4 h (T4) after skin incision for determination of plasma levels of cortisol, GH, IL- 6 and IL-8.Results
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2004年第4期256-259,共4页
Chinese Journal of Anesthesiology
