文章摘要
陈祖萍,钱燕宁,韩传宝,刘 华,韩素萍.硬膜外麻醉可减轻无气腹腹腔镜妇科手术应激反应[J].南京医科大学学报,2008,28(9):1158~1161
硬膜外麻醉可减轻无气腹腹腔镜妇科手术应激反应
Effects of anesthestic techniques on stress response to gynecological laparoscopic operation without pneumoperitoneum
投稿时间:2008-04-03  
DOI:10.7655
中文关键词: 麻醉  无气腹腹腔镜  应激
英文关键词: anesthesia  gasless laparoscopic  stress
基金项目:江苏省医学重点人才资助(RC2002058)
作者单位
陈祖萍 南京医科大学第一附属医院麻醉科,江苏 南京 210029 
钱燕宁 南京医科大学第一附属医院麻醉科,江苏 南京 210029 
韩传宝 南京医科大学第一附属医院麻醉科,江苏 南京 210029 
刘 华 南京医科大学第一附属医院麻醉科,江苏 南京 210029 
韩素萍 南京医科大学第一附属医院妇产科,江苏 南京 210029 
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中文摘要:
      目的:比较在不同麻醉方法下行无气腹腹腔镜妇科手术对血糖?胰岛素?皮质醇及TNF-α的影响?方法:选择38例择期行妇科腹腔镜手术,并根据美国麻醉医师协会(ASA)标准确定为Ⅰ~Ⅱ级的患者,随机分成2组,每组19例?Ⅰ组,于静脉全麻下行无气腹腹腔镜手术;Ⅱ组,于硬膜外麻醉下行无气腹腹腔镜手术?监测2组患者麻醉前(T1)?气腹或悬吊建立后30 min(T2)?气腹或悬吊撤除后10 min(T3)和术后第2天晨8时(T4)4个时点的血糖?胰岛素?皮质醇?和TNF-α浓度?结果:麻醉前患者的血糖?胰岛素?皮质醇和TNF-α水平无明显差别(P > 0.05),术后各水平均逐渐升高?组间比较,Ⅰ组在T3时点的血糖?胰岛素水平和TNF-α高于Ⅱ组(P < 0.05);Ⅰ组的血皮质醇水平在T3和T4时点均高于Ⅱ组(P < 0.01和P < 0.05)?结论:与全麻比较,硬膜外麻醉可减弱无气腹腹腔镜妇科手术的应激反应?
英文摘要:
      Objective:To study the changes of serum blood glucose,insulin,cortisol and TNF-α in patients underwent gynecological laparoscopic operations using abdominal wall-lifting methods under different anesthesia. Methods:Thirty-eight patients scheduled for gynecological laparoscopy,ASAⅠ~Ⅱ,were randomly divided into two groups(Ⅰ,Ⅱ) with 19 cases in each group respectively. Patients of groupⅠwere operated under general anesthesia and gasless technique. Patients of groupⅡ went through the same operative procedures under epidural anesthesia and gasless technique. All patients were monitored including blood glucose,insulin,cortisol,TNF-α at four time points:before anesthesia(T1),at 30 min after the operations beginning(T2) and 10 min after the end of the surgery(T3) and at 8 AM in the next morning(T4). Results:There were no obvious differences in blood glucose,insulin,cortisol and TNF-α between the two groups at T1(P > 0.05),and these values increased after the beginning of the operations, reaching their peak values at T4. The levels of blood glucose, insulin and TNF-α were higher in groupⅠ than those in group Ⅱ at T3(P < 0.05). Levels of serum cortisol were higher in groupⅠ than those in group Ⅱat T3(P < 0.01)and T4(P < 0.05). Conclusion:Compared with general anesthesia,epidural anesthesia might reduce stress responses in patients underwent gynecological gasless laparoscopic operation.
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