腹腔镜下子宫全切术45例患者不同麻醉方法的应激反应比较

目的:探讨不同麻醉方法对机体的应激反应情况。方法:对2008年6月～2009年1月在我院择期行腹腔镜下子宫全切术45例患者,随机分为全麻复合硬膜外麻醉组(A组)23例和全麻组(B组)22例,比较两组患者在麻醉前、麻醉后5min、术中、术毕等不同时间点的肾素、血管紧张素Ⅱ、醛固酮、皮质醇、胰岛素、血糖、生长素等指标的变化情况。结果:两组血糖均于麻醉5min后下降,与麻醉前比差异均有统计学意义(P<0.05);术中A组血糖恢复至麻醉前水平,差异无统计学意义(P>0.05);而B组则较麻醉前显著增高(P<0.05);术毕两组血糖均较麻醉前显著升高,差异有统计学意义(P<0.05)。A组患者在术中及术毕的血糖变化与B组比较,差异有统计学意义(P<0.05);两组患者麻醉前内分泌各指标(肾素、血管紧张素Ⅱ、醛固酮、皮质醇、胰岛素、生长素)水平比较,差异均无统计学意义(P>0.05)。麻醉后A组患者的血管紧张素Ⅱ、醛固酮、皮质醇、胰岛素、生长素和B组的血管紧张素Ⅱ、醛固酮等指标在不同时间点的变化与与麻醉前比,差异均无统计学意义(P>0.05);而在麻醉5min、术中、术毕时,A组患者肾素活性则均较麻醉前有所下降,而B组肾素活性则在术中时较麻醉前升高,差异均有统计学意义(P<0.05)。B组皮质醇、生长素则于术中、术毕较麻醉前显著升高,胰岛素则在术中、术毕时较麻醉前显著降低,差异有统计学意义(P<0.05)。术中A组肾素、皮质醇、胰岛素、生长素水平与B组比较,差异均有统计学意义(P<0.05)。结论:两种麻醉方法均引起应激反应,但全麻复合硬膜外麻醉较单纯全麻引起的应激反应轻,利于患者术后转归。

Comparison of stress responses in 45 patients anaesthetized by different methods during laparoscopic hysterectomy

Objective：To observe stress responses in patients anaesthetized by different methods during laparoscopic hysterectomy.Methods：Forty five patients that underwent scheduled laparoscopic hysterectomy June 2008 January 2009 in our hospital were randomly divided into general anesthesia combined with epidural anesthesia group（group A,23 cases）and general anesthesia group（group B,22 cases）.Changes in parameters including renin,angiotensin Ⅱ,aldosterone,cortisol,insulin,glucose,growth hormone were recorded and compared before the start of anesthesia,5 min after anesthesia,during the surgery.Results：Blood glucose decreased 5 min after anesthesia in both groups showing significant differences compared that before anesthesia（P〈0.05）;however,it came back to the original levels in group A（P〉0.05）and even higher than the original one in group B during the surgery（P〈0.05）.When the surgery ended,blood glucose were higher than that before the operation in both groups（P〈0.05）.The original levels of renin,angiotensin Ⅱ,aldosterone,cortisol,insulin,glucose,growth hormone were not significant different between group A and group B.In group A,no changes in these parameters were found（P〉0.05）except for rennin,which decreased significantly 5 min at the observed time points.On the contrary,rennin increased significant in group B（P〈0.05）.During the surgery,levels of renin,cortisol,insulin,growth hormone in group A were significant different from that in group B（P〈0.05）.Conclusion：Stress responses can be induced by both general anesthesia combined with epidural anesthesiaand general anesthesia,but less by the former one,which is favorable for the patients prognosis.