喉罩通气-七氟醚吸入全麻复合肋间神经阻滞对乳腺癌改良根治术患者应激反应的影响

目的 观察喉罩通气-七氟醚吸入全麻复合肋间神经阻滞对乳腺癌改良根治术患者应激反应的影响.方法 选择2007年10至11月ASA Ⅰ～Ⅱ级拟在全麻下行乳腺癌改良根治术的患者60例,随机分为喉罩通气-七氟醚吸入全麻组(Ⅰ组)和喉罩通气-七氟醚吸入全麻复合肋间神经阻滞(Ⅱ组),每组30例.分别测定麻醉前、切皮时、切皮后1 h、术毕拔喉罩后5 min时各时间点血浆皮质醇(cor)和血管紧张素-Ⅱ(A-Ⅱ)水平,并记录各时间点的平均动脉压(MAP)和心率(HR).结果 血浆cor在拔喉罩后5 min时2组均高于麻醉前,在切皮时及拔喉罩后5 min时Ⅰ组高于Ⅱ组;A-Ⅱ在拔喉罩后5 min时2组均高于麻醉前,但Ⅰ组高于Ⅱ组;MAP和HR在拔喉罩后5 min时Ⅰ组高于Ⅱ组.结论 喉罩通气-七氟醚吸入全麻复合肋间神经阻滞能减轻乳腺癌改良根治术患者的应激反应.

Effects of combined intercostal nerves block-sevoflurane used inhalation anesthesia with laryngeal mask ventilation on the stress response in patients suffered from breast neoplasms undergong modified radical mastectomy

Objective To investigate the influence of combined intercostal nerves block-sevoflurane used inhalation anesthesia with laryngeal mask ventilation on the stress response to modified radical mastectomy. Methods 60 patients with ASA physical status Ⅰ-Ⅱ, aged 33-53 years and scheduled for modified radical mastectomy were randomly divided into group Ⅰ and group Ⅱ. 30 cases each group. Patients in both groups received modified radical mastectomy under sevoflurane used inhalation anesthesia with laryngeal mask ventilation, and group Ⅱ received intercostal nerves block befor anesthesia induction. Blood samples were taken before anesthesia,at incision,one hour after incision and 5 munites after the end of surgery for determination of serum concentration of cortisol and angiotension. Blood pressure and heart rate of patients was also recorded during the operation. Results Compared with the baseline value before anesthesia,serum cortisol and angiotension increased 5 munites after the end of surgery in both groups,but the concentration in group Ⅰ were higher than that in group Ⅱ. At incision the concentration of cortisol in group Ⅰ were higher than the baseline value and the same time in group Ⅱ. Conclusion Combined intercostal nerves block-sevoflurane used inhalation anesthesia with laryngeal mask ventilation can reduce the stress response in patients undergong modified radical mastectomy.