摘要
目的 研究全身麻醉复合硬膜外麻醉对心胸外科手术应激反应影响及血清血小板活化因子(PAF)、干扰素-γ(IFN-γ)水平变化.方法 选取2017年5月至2018年6月上海市第六人民医院东院心胸外科手术患者106例,采取全身麻醉者53例设为对照组,全身麻醉复合硬膜外麻醉者53例设为观察组.观察和比较两组观察对象手术时间、麻醉时间、苏醒时间、麻醉药物使用剂量和术后72h内并发症发生率及麻醉诱导前(T0)、全身麻醉诱导后(T1)、手术完毕时(T2)、术后24h(T3)应激反应指标(血糖、去甲肾上腺素)及PAF、IFN-γ水平.结果 观察组手术时间、麻醉时间与对照组比较,差异无统计学意义(P>0.05);苏醒时间及丙泊酚、舒芬太尼、维库溴铵药物使用剂量少于对照组,差异有统计学意义(P<0.05).观察组术后感染构成比5.66%、躁动构成比1.89%及死亡构成比0.00%均低于对照组的9.43%、3.77%、1.89%,差异有统计学意义(P<0.05).T0时,两组观察对象血糖、去甲肾上腺素、PAF、IFN-γ水平分别比较,差异无统计学意义(P>0.05).但T0、T1、T2、T3时,两组患者血糖水平、去甲肾上腺素、PAF水平均呈先升高、后下降状态,IFN-γ水平先下降、后升高;但各个时刻,观察组血糖水平、去甲肾上腺素、PAF水平低于对照组,IFN-γ水平高于对照组,差异有统计学意义(P<0.05).结论 全身麻醉复合硬膜外麻醉相对单纯的全身麻醉,更利于减轻心胸外科手术应激反应,尽可能维持机体正常生理代谢功能,从而避免血清PAF、IFN-γ水平过度波动,有助于降低心胸外科术后感染率,安全性及可行性优势显著,值得推广.
Objective To study the effects of general anesthesia combined with epidural anesthesia on stress response in cardiothoracic surgery and the changes of platelet activating factor(PAF)and interferon—gamma(IFN-gamma)levels in serum.Methods From May 2017 to June 2018,106 patients with cardiothoracic surgery in the Eastern Hospital of Shanghai Sixth People's Hospital were selected.Among them,53 patients underwent general anesthesia as a control group and 53 patients underwent general anesthesia combined with epidural anesthesia was a research group.The operation time,anesthesia time,awakening time,dosage of anesthetics,incidence of complications within 72 hours after operation,pre—induction of anesthesia(TO),post—induction of general anesthesia(T1),post—operation(T2),24 hours after operation(T3)stress response indicators(blood sugar,norepinephrine),PAF,IFN—gamma levels were observed and compared between the two groups.Results There was no significant difference in operation time and anesthesia time between the study group and the control group(P>0.05),but the recovery time and dosage of propofol,sufentanil and vecuronium were less than those of the control group(P<0.05).Postoperative infection,restlessness and mortality in the study group were 5.66%,1.89%and 0.00%lower than those in the control group(9.43%,3.77%,1.89%,P<0.05).At TO,there was no significant difference in blood glucose,norepinephrine,PAF and IFN—gamma levels between the two groups(P>0.05).But at TO,T1,T2,T3,the blood glucose,norepinephrine,PAF levels of the two groups were first increased,then decreased,IFN-gamma levels first decreased,then increased,but at each time,the blood glucose level,norepinephrine,PAF levels of the study group were lower than the control group,IFN—gamma levels were higher than the control group,the difierence was statistically significant(P<0.05).Conclusion General anesthesia combined with epidural anesthesia is relatively simple general anesthesia,which is more conducive to aDeviating the stress response of cardiothoracic surgery and maintaining the normal physiological and metabolic function of the body as far as possible,thus avoiding excessive fluctuation of serum PAF and IFN-ganinia levels,and contributing to reducing the infection rate after cardiothoracic surgery.lt has obvious advantages in safety and feasibility,and is worth popularizing.
出处
《浙江临床医学》
2019年第12期1704-1706,共3页
Zhejiang Clinical Medical Journal
关键词
全身麻醉复合硬膜外麻醉
应激反应
血小板活化因子
干扰素-γ
General anesthesia combined with epidural anesthesia
Stress response Platelet activating factor
Interferon-gamma
