联合麻醉下施行上腹部手术对病人应激和免疫功能的影响

目的：通过测定儿茶酚胺（CA）、皮质醇、白细胞介素－2（IL－2）可溶性白细胞介素2－受体（SIL－2R），观察全麻联合硬膜外阻滞对上腹部手术病人应激激素和免疫功能的影响。方法：选择性上腹部手术病人30例，随机分成全麻联合硬膜外阻滞组（n=15)和单纯全麻组（n=15)。两组病人分别于麻醉前、麻醉诱导后切皮前、手术结束前、术后第1天、术后第3天采血，测定血浆中CA、血清中皮质醇、IL－2、SIL－2R浓度。结果：肾上腺素（E）水平在联合组无明显变化，全麻组在手术结束前、术后第1天都升高（P＜0．01）。去甲肾上腺素（NE）浓度在联合组麻醉诱导后出现降低（P＜0．05），而手术结束前及术后第1、3天与麻醉前相比均无明显变化。全麻组病人在麻醉诱导后无明显变化，而在手术结束前术前术术后第1天升高（P＜0．01），术后第3天仍未恢复到麻醉前水平。皮质醇浓度两组病人的变化相仿，在麻醉诱导后都呈降低趋势（P＜0．05）。IL－2在联合组的任何采样点与麻醉前比较均无明显变化，而在全麻组，手术结束前降低（P＜0．01），与联合组相同采样点比也降低（P＜0．05）。两组病人SIL－2R在麻醉诱导后及手术后均无明显变化。结论：在上腹部手术，联合麻醉在抑制病人的应激反应及保护免疫功能方面优于单纯全麻。

Influence of General Anesthesia Combined with Epidrual Blockade on Stress and Immune Function in Upper Abdominal Surgery

To study the effects of general anesthesia combined with epidural blockade on stress response and immune function by measuring of IL-2,sIL-2R,CA,and cortisol in upper abdominal surgery. Methods:Thirty patients who underwent upper abdominal operation were randomized into two groups which included general anesthesia group (group G, n = 15) and general anesthesia combined with epidural blockade group (group G E, n = 15). Peripheral venous blood samples were obtained in all patients before and after induction of anesthesia,at the end of operation,and 1 ,and 3 days postopera-tively. Results:Epinephrine (E) increased at the end of operation and 1 day postoperatively in group G (P<0.01),and there was no significant change in group G E ( P > 0.05 ) . Norepinephrine ( NE) decreased after anesthesia induction in group G E (P<0.05),and there was no significant change at the end of operation, 1,and 3 days postoperatively (P> 0.05).In group G,NE significantly increased at the end of operation, 1,and 3 days postoperatively (P<0.01 and P< 0.05, respectively). Cortisol decreased after anesthesia in two groups ( F < 0.05 ) . IL-2 decreased at the end of operation in group G (P<0.05) ,and there was no change in group G E.There was no significant change of sIL-2R in two groups after anesthesia and operation (P>0.05) . Conclusion:Combined anesthesia in a more effective method in suppressing stress and protecting immune function in upper abdominal surgery than simple general anesthesia.