七氟醚复合全麻对上腹部手术应激反应的影响

目的 探讨吸入七氟醚全麻基础上复合硬膜外阻滞或瑞芬太尼靶控输注对上腹部手术患者应激反应的影响。方法选择60例ASAⅠ～Ⅱ级拟行上腹部手术患者随机分为3组（n=20）：对照组（七氟醚维持）、瑞芬太尼组（七氟醚＋瑞芬太尼靶控输注）、硬外组（七氟醚＋硬膜外阻滞）。所有患者入室后常规监护ECG、血压、血氧饱和度，行中心静脉穿刺及桡动脉穿刺测压后，快速诱导插管。记录三组麻醉前（T1）、插管后即刻（T2）、手术开始即刻（T3）、手术开始后30min（T4）及术毕（T5）的平均动脉压（MAP）、心率（HR）、脑电双频谱指数（BIS）及测量末梢血糖（Glu）、乳酸（Lac）、血浆皮质醇（Cor）浓度。记录拔管时间及术后恶心呕吐。结果硬膜外组及瑞芬组术中皮质醇浓度均较对照组低，术后皮质醇浓度瑞芬组低于对照组及硬膜外组。结论七氟醚复合瑞芬太尼靶控输注或硬膜外阻滞的全麻比单用七氟醚更有效减轻术中应激反应。

Effects of combined sevofluorine general anesthesia on stress reaction of upper abdominal surgery

Objective To investigate the stress reaction of patients undergoing upper abdominal surgery under sevoflurane inhalation anesthesia or combined with either epidural block or remifentanil target-controlled infusion. Methods 60 patients of ASA Ⅰ- Ⅱundergoing selective upper abdominal surgery under general anesthesia were randomly divided into three groups （n=20）： control group （sevoflurane only）, remifentanil group （sevoflurane＋remifentanil target-controlled infusion） and epidural block group （sevoflurane＋epidural block）. Monitoring including ECG, blood pressure, oxygen saturation,central venous pressure and arterial blood pressure were performed before surgery,then rapid sequence intubation. Mean arterial pressure （MAP）, heart rate （HR）, bispectral index （BIS）, peripheral blood glucose （ Glu ）, lactate （Lac）, plasma cortisol concentrations （Cor） were recorded before anesthesia （T1）, after intubation （T2）, beginning of operation （T3）, 30min after operation（T4） and operation end （TS）. Extubation time, postoperative nausea and vomitting （PONV）were recorded. Results Intraoperative cortisol concentrations in epidural block group and remifentanil group were significantly lower than those in control group. Postoperative cortisol concentrations in remifentanil group were significantly lower than those in control group and epidural block group. Percentage of PONV in control group was higher than those in remifentanil group and epidural block group. Conclusions Sevoflurane combined with remifentanil target-controlled infusion and epidural anesthesia would suppress intraoperative stress reaction more effectively than sevoflurane alone.