全麻联合硬膜外阻滞及术后镇痛对上腹部手术围术期生长激素、胰岛素和血糖的影响.docVIP

???? 全麻联合硬膜外阻滞及术后镇痛对上腹部手术围术期?生长激素、胰岛素和血糖的影响 ???? ????摘要　目的：观察全麻联合硬膜外阻滞并保留术后镇痛对围术期上腹部手术应激反应和糖代谢的影响。方法：择期胆囊切除病人30例，随机分为三组，每组10例，Ⅰ组全麻联合硬膜外阻滞并保留术后镇痛，Ⅱ组硬膜外阻滞保留术后镇痛，Ⅲ组硬膜外阻滞不保留术后镇痛。观察围术期血浆生长激素（GH）、血糖（BS）和胰岛素（Ins）浓度变化。结果：与麻醉前比，Ⅰ组术中和术后GH、BS平稳，Ⅱ、Ⅲ组术中和术毕即刻BS明显升高，但术后24小时Ⅱ组降到正常，Ⅲ组BS仍显著升高。术毕即刻Ⅱ、Ⅲ组GH均显著升高，术后24小时Ⅱ组GH恢复正常，Ⅲ组GH仍持续升高。术后三组Ins均有明显升高。结论：全麻联合硬膜外阻滞并施行术后镇痛较单纯硬膜外麻醉能更有效地减轻术中应激反应。　　关键词　全麻　硬膜外阻滞　镇痛　血糖　胰岛素　生长激素 Effect of the Combined General-Epidural-Anesthesia and Postoperative Analgesia on Blood Glucose，Insulin and Growth Hormone in Patients Undergoing Upper Abdominal Surgery Cheng Meijuan，Zhang Jin，Song Jie，et al（Department of Anesthesiology，Second Affiliated Hospital，Nantong Medical College 226001） 　　Abstract　Objective：To evaluate the effect of general anesthesia combined with epidural block and postoperative epidural analgesia on perioperative blood sugar（BS），insulin（Ins）and growth hormone（GH） in patients undergoing upper abdominal．Methods：30 patients undergoing elective cholecystectomy were allocated into 3 groups with 10 cases each．The patients in group Ⅰ received general anesthesia combined with epidural block and postoperative analgesia，and the patients in group Ⅱ received epidural block and postoperative epidural analgesia，the remaining patients in group Ⅲ received epidural analgesia only during surgery．Results：The levels of plasma GH and BS in group Ⅰ were stable during and after operation．The BS in group Ⅱ and Ⅲ was significantly increased during operation and at the end of operation，compared with that before anesthesia．But the levels of BS in group Ⅱ returned to the normal on the first postoperative day．At the end of operation，the concentration of plasma GH in group Ⅱ and Ⅲ was significantly increased in comparison with that before anesthesia，which returned to the normal on the first day after operation in group Ⅱ and was still on the high level until second postoperative day．The concentration of plasma insulin in all 3 groups were significantly increased on th