七氟醚可改善腹腔镜盆腔手术期间的神经内分泌应激反应。

Sevoflurane improves the neuroendocrine stress response during laparoscopic pelvic surgery.

作者信息

Marana Elisabetta, Annetta Maria Giuseppina, Meo Francesco, Parpaglioni Raffaella, Galeone Marina, Maussier Maria Luisa, Marana Riccardo

机构信息

Department of Anesthesiology, Intensive Care and Emergency Medicine, Catholic University of the Sacred Heart, Largo Francesco Vito 1, I-00168 Rome, Italy.

出版信息

Can J Anaesth. 2003 Apr;50(4):348-54. doi: 10.1007/BF03021031.

DOI:10.1007/BF03021031

PMID:12670811

Abstract

PURPOSE

Stress response to surgery is modulated by several factors, including magnitude of the injury, type of procedure (e.g., laparoscopy vs laparotomy) and type of anesthesia. Our purpose was to compare intra- and postoperative hormonal changes during isoflurane vs sevoflurane anesthesia, in a clinical model of well defined operative stress (laparoscopic pelvic surgery).

METHOD

In this prospective randomized clinical study, 20 women requiring laparoscopic pelvic surgery for benign ovarian cysts received either a standard isoflurane plus fentanyl (Group A) or sevoflurane plus fentanyl anesthesia (Group B). Blood samples were collected preoperatively, 30 min after the beginning of surgery, at the end of surgery after extubation, and two and four hours after the end of surgery. Intra- and postoperative plasma levels of norepinephrine, epinephrine, adrenocorticotropic hormone (ACTH), cortisol, growth hormone (GH) and prolactin (PRL) were measured.

RESULTS

Catecholamine levels and postoperative pain were similar in both groups. Nonetheless, in comparison to Group A, Group B showed a significant decrease of ACTH, cortisol and GH levels (A vs B at the end of surgery: ACTH 160 +/- 45 vs 100 +/- 40 pg.mL(-1); cortisol 45 +/- 8 vs 23 +/- 7 microg.dL(-1); GH 3 +/- 2 vs 0.8 +/- 0.4 ng.mL(-1); P < 0.001 for all), but enhanced PRL levels (A vs B, at 30 min after the beginning of surgery: 139 +/- 54 vs 185 +/- 22 ng.mL(-1); at the end of surgery: 100 +/- 27 vs 141 +/- 45 ng.mL(-1); P < 0.001 for both).

CONCLUSIONS

In the clinical setting of low stress laparoscopic surgery, the type of volatile anesthetic significantly affected the stress response; the changes associated with sevoflurane suggested a more favourable metabolic and immune response compared to isoflurane.

摘要

目的

手术应激反应受多种因素调节，包括损伤程度、手术类型（如腹腔镜手术与开腹手术）及麻醉类型。我们的目的是在明确界定手术应激的临床模型（腹腔镜盆腔手术）中，比较异氟烷与七氟烷麻醉期间及术后的激素变化。

方法

在这项前瞻性随机临床研究中，20例因良性卵巢囊肿需行腹腔镜盆腔手术的女性患者，分别接受标准异氟烷加芬太尼（A组）或七氟烷加芬太尼麻醉（B组）。于术前、手术开始后30分钟、拔管后手术结束时以及手术结束后2小时和4小时采集血样。测定术中和术后血浆去甲肾上腺素、肾上腺素、促肾上腺皮质激素（ACTH）、皮质醇、生长激素（GH）和催乳素（PRL）水平。

结果

两组的儿茶酚胺水平及术后疼痛相似。然而，与A组相比，B组的ACTH、皮质醇和GH水平显著降低（手术结束时A组与B组：ACTH 160±45 vs 100±40 pg.mL⁻¹；皮质醇：45±8 vs 23±7 μg.dL⁻¹；GH 3±2 vs 0.8±0.4 ng.mL⁻¹；所有P<0.001），但PRL水平升高（手术开始后30分钟A组与B组：139±54 vs 185±22 ng.mL⁻¹；手术结束时：100±27 vs 141±45 ng.mL⁻¹；两者P<0.001）。