不同麻醉方式对老年人上腹部手术应激和免疫功能的影响.docVIP

　　不同麻醉方式对老年人上腹部手术应激和免疫功能的影响 【摘要】 目的 探讨3种麻醉方式对老年人上腹部手术应激和免疫功能的影响。方法 48例择期上腹部手术的老年患者随机分为3组：硬膜外阻滞组(A组)、单纯全麻组(B组)、硬膜外阻滞加全麻组(C组)。分别于不同时间点抽取外周静脉血采用高效液相色谱法测定肾上腺素（E）、去甲肾上腺素（NE）、采用放射免疫分析法测定皮质醇、采用酶联免疫分析法(ELISA)测定白细胞介素-6(IL-6)、白细胞介素-8（IL-8）和肿瘤坏死因子-α（TNF-α）水平。结果 麻醉诱导后B、C组皮质醇降低，与诱导前比较差异有显著性意义（P＜0.05）；A、B组手术60 min 至术后3 d，皮质醇有不同程度的升高，C组无明显变化；3组E、NE均于手术结束前、术后1 d均显著高于诱导前（P＜0.01），但C组低于A、B两组（P＜0.05或P＜0.01）；3组患者的血浆TNF-α水平无显著变化，IL-6、IL-8在手术60 min、手术结束前均较诱导前显著升高（P＜0.05），而A、B组持续时间长至术后3 d，C组于术后1 d恢复至诱导前水平。结论 3种麻醉方法均不能完全阻断手术创伤性刺激导致的应激反应，硬膜外阻滞复合全麻用于老年患者行上腹部手术，应激反应小，全麻药用量小，利于保持各系统功能的稳定和术后镇痛。 【关键词】 硬膜外麻醉 全身麻醉 应激 炎性因子 Abstract：Objective To pare the effects of three different anesthesia methods on the stress and immune function in upper abdominal surgery of elderly patients. Methods 48 patients ly divided into three groups: epidural anesthesia alone (group A),general anesthesia alone(group B)and epidural anesthesia bined e points ination of epinephrine, norepinephrine，radioimmunoassay used for the determination of cortisol and enzyme-linked immuno assay (ELISA) used for TNF-α, IL-6, IL-8. Results Cortisol decreased after anesthesia induction in group B and C（Plt;0.05）. It increased at 60 minutes after operation and remained high at the third postoperative day in group A and B，group C remained unchanged. E, NE rose significantly in three groups at the end of operation and on the first postoperative day（Plt;0.01）,but group C ained unchanged in three groups, IL-6,IL-8 rose significantly in 60 minutes after operation and the end of operation in three groups（Plt;0.05）.It remained high at the third postoperative day in group A and B，and decreased to the level before anesthesia in group C at the first postoperative day. Conclusions Epidural block bined inal surgery, and helps reduce traumatic stimulation produced by surgical operation. Key g。A组T8～9或T9～10穿刺行硬膜外阻滞，麻醉平面控制在T6～12，术前推注利多卡因300～400 mg，每40～60 min追加100 mg。B组依次缓慢静注咪唑安定0.04 mg/kg、丙泊酚1.5～2.5 mg/kg、芬太尼2～4 μg/kg及维库溴铵0.1 mg/kg诱导插管；C组在T8～9或T9～10