术后镇痛与无术后镇痛对开胸术后应激反应的临床观察

目的观察术后镇痛与无术后镇痛对胸部手术患者应激激素的影响。方法42例肺癌手术患随机分为全麻复合硬膜外腔阻滞并术后镇痛（GEA）组和全麻（GA）无术后镇痛组，每组24例，分别测定麻醉诱导前，手术2h、术毕、术后1d的血浆去甲肾上腺素、肾上腺素、内皮素、C-反应蛋白、皮质醇的水平。结果GEA组的血浆去甲肾上腺素、内皮素和血清皮质醇，术中、术后差异无显著性（p〉0．05），与GA组比较差异有非常显著性（P〈0．01）。两组血浆去肾上腺素，术中、术后差异均无显著性（P〉0．05）。两组血清C-反应蛋白，术中、术后均显著升高（P〈0．01），组间比较差异无显著性。结论全麻复合硬外腔阻滞可以减轻胸部手术的应激反应，促进呼吸功能的恢复。

the effect of wih-or-without analgesia after chest operation on stress hormone

Objective To study the effect of different anesthetic methods on stress hormone in chest openration. Mehhods Forty-two patients withs pulmonary carcinoma were randomly divided into two even groups： general anesthesia （GA）group general anesthesia plus epidural anesthesia （GEA） group. Plasma levels of norepinephrine, adrenaline ,endothelin, C-reaction protein （CRP）and cortisol were detcted before anesthesia induction,at 2 hours during operation,at the end of operation and on the 1st postopenrative day, respectively. Results The contents of norepinephrine, endothelin and cortisol in GFA group were markedly lower than thoes in GA group （p〈0.01）.CRP leve in two groups was increased significantly during and after operation compared with before operation （p〈0.01）.There was no statistical difference in adrenaline concentration between pre-and post-operation in two groups （p〉0.05）.Conclusion Stress response can be relieved by epidural anesthesia in patients undergoing thoracic operation .