全麻并胸段硬膜外阻滞开胸手术患者血糖、胰岛素、血皮质醇的水平.docVIP

全麻并胸段硬膜外阻滞开胸手术患者血糖、胰岛素、血皮质醇的水平 作者：兰自侃，杨 瑞，张 昕，杨春艳，徐 伟 【关键词】 麻醉 关键词: 麻醉，全身;麻醉，硬膜外;应激 摘 要:目的 通过检测单纯全麻或全麻并胸段硬膜阻滞开胸手术患者的血糖、血清皮质醇、胰岛素浓度及观察血流动力学的变化，比较两种麻醉方法对抑制手术时应激反应的差异. 方法 将20例ASAⅠ～Ⅱ级开胸手术患者随机分为两组（n=10）:G组按照常规方法诱导后进行气管内插管全麻，术中静吸复合维持麻醉;G+C组先行胸6～7椎间隙硬膜外穿刺置管后再行气管内插管全麻，在静吸复合全麻的同时硬膜外腔给予3.75g#12539;L-1 布比卡因.分别在麻醉前、切皮后10min、胸腔探查，关胸时4个时间点记录血流动力学变化并采静脉血测定血清皮质醇、胰岛素、血糖纪录. 结果 G组皮质醇在切皮251.4±18.2，探查260.5±139.7及关胸时271.6±133.3均高于G+C组182.6±83.5，188.6±103.3和263.0±86.9（Plt;0.05）;胰岛素仅在关胸时G组18.1±13.7高于G+C组12.6±4.6（Plt;0.05）;血糖值G组在胸腔探查6.7±0.8，关胸时8.8±1.1比G+C组6.5±1.2及8.0±1.1高（Plt;0.05）;SBP G组切皮时17.1±1.4、探查时16.4±2.5比G+C组同一时点14.8±2.1及12.9±1.8高（Plt;0.05）. 结论 开胸手术时使用全麻加硬膜外阻滞能有效的抑制手术引起的应激反应，使患者在术中更为安全平稳，麻醉效果更为可靠. 　　Keywords:anesthesia，general;anesthesia，epidural;stress 　　Abstract:AIM To compare the stress responses to thoraco-tomy under general anesthesia and combined general-epidural anesthesia.METHODS Twenty ASAⅠ～Ⅱpatients un-dergoing elective thoracotomy were randomly divided into two groups（n=10）:Group G（general anesthesia）and Group G+C（combined general-epidural anesthesia）.Group G received combined inhale-intravenous anesthesia only dur-ing the operation.Group G+C received combined inhale-in-travenous anesthesia and at the same time3.75g#12539;L-1 bupi-caine was given through thoracic epidural cavity during the operation.Plasma concentrations of cortisone，insulin，glu-cose and hemodynamics were measured before the anesthesia，10min after the incision，and when the thoracic cavity was explored and closed.RESULTS Cortisones were higher sig-nificantly in Group G than those in Group G+C10min after the incision，exploration and closing thoracic cavity（251.4±18.2vs182.6±83.5，260.5±139.7vs188.6±103.3，271.6±133.3vs263.0±86.9）（Plt;0.05）.Insulin was higher in Group G（18.1±13.7）than that in Group G+C（12.6±4.6）（Plt;0.05）at closing thoracic cavity.Glucoses were higher in Group G（6.7±0.8，8.8±1.1）than those in Group G+C（6.5±1.2，8.0±1.1）at explorati