文章摘要
王俊林,张斯璧,刘存明,仲 山,费 建.不同麻醉方法对新生儿巨结肠根治术围术期应激反应的影响[J].南京医科大学学报,2009,29(9):1289~1292
不同麻醉方法对新生儿巨结肠根治术围术期应激反应的影响
Effects of different anesthetic techniques on neonate perioperative stress in the radical operation of hirschsprung’s disease
投稿时间:2009-05-06  
DOI:10.7655
中文关键词: 新生儿  骶管阻滞  应激反应  皮质醇  白介素-6
英文关键词: neonate  caudual block  stress  cortisol  interleukin-6
基金项目:
作者单位
王俊林 南京医科大学附属南京儿童医院麻醉科,江苏 南京 210008 
张斯璧 南京医科大学附属南京儿童医院麻醉科,江苏 南京 210008 
刘存明 南京医科大学第一附属医院麻醉科,江苏 南京 210009 
仲 山 南京医科大学附属南京儿童医院麻醉科,江苏 南京 210008 
费 建 南京医科大学附属南京儿童医院麻醉科,江苏 南京 210008 
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中文摘要:
      目的:探讨不同麻醉方式对新生儿巨结肠根治术围术期应激反应的影响?方法:40 例asaⅠ~Ⅱ级择期行巨结肠根治术的新生儿,随机分为全麻组(ga组,n = 20)和骶管阻滞复合全麻组(cb组,n = 20)?两组均采用芬太尼?咪唑安定和罗库溴铵静脉诱导,七氟醚吸入维持麻醉,cb组于诱导后行单次骶管阻滞?分别于麻醉前(t1)?手术开始(t2)和开始后30 min(t3)?手术结束后30 min(t4)和24 h(t5),采中心静脉血测定血清皮质醇(cortisol)和il-6浓度,记录心率(hr)?收缩压(sbp)和舒张压(dbp)?结果:与t1比较,ga组t4时sbp?dbp和hr升高(p < 0.05),且分别高于同时点的cb组(p < 0.05)?与t1比较,ga组血清cortisol浓度于t4,5时升高(p < 0.05),且高于cb组t4,5时(p < 0.05)?与t1时点相比,ga组和cb组血清il-6水平在t3-5均升高(p < 0.05),与cb组相比,ga组血清il-6水平在t4,5时点明显高于cb组(p < 0.05)?结论:新生儿围术期具有较强的应激反应,骶管阻滞复合全麻在调节围术期应激反应方面优于单纯全麻?
英文摘要:
      objective:to study the effects of different anesthetic techniques on neonate perioperative stress response in the radical operation of hirschsprung’s disease. Methods:forty asaⅠ~Ⅱ neonate patients were randomly assigned into ga group and cb group with 20 each. Anesthesia in ga group was induced with fentanyl,midazolam,rocuronium and maintained with sevoflurane inhalation. Caudual block was performed in cb group after induction. Blood samples were taken before induction of anesthesia (t1),at beginning of operation (t2),30 min after incision(t3),30 min after operation(t4) and 24 hours after operation(t5). Serum levels of cortisol and interleukin-6(il-6) were measured. Systolic blood pressure(sbp),diastolic blood pressure(dbp) and heart rate(hr) were recorded at the same time. Results:in ga group,hr,sbp and dbp were significantly higher at t4 than those at t1 (p < 0.05). Hr,sbp and dbp were significantly higher at t4 in ga group than those in cb group(p < 0.05).compared with those at t1,the concentrations of cortisol at t4,5 were significantly higher in ga group(p < 0.05). The concentrations of cortisol at t4,5 in ga group were significantly higher than those in cb group(p < 0.05). Compared with those at t1,the concentrations of il-6 at t3-5 were significantly higher in both groups(p < 0.05). The concentrations of il-6 at t4,5 in ga group were significantly higher than those in cb group(p < 0.05). Conclusion:severe perioperative stress response may occur in neonate. General anesthesia combined with caudual block is superior to general anesthesia in alleviating the neonate perioperative stress response.
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