Carli F, Webster J, Nandi P, MacDonald I A, Pearson J, Mehta R
Department of Anaesthesia, Northwick Park Hospital, Medical Research Council Clinical Research Centre, Harrow, Middlesex, United Kingdom.
Am J Physiol. 1992 Sep;263(3 Pt 1):E441-7. doi: 10.1152/ajpendo.1992.263.3.E441.
Body temperature, respiratory gas exchange, and plasma catecholamines were determined before and after surgery in three groups [control (C), warmed (W), and epidural (E) who received local anesthetic at T4-S5 dermatomes during and for 24 h after surgery] of patients undergoing colonic surgery under general anesthesia. At the end of surgery, group W were nursed in an ambient temperature of 28-30 degrees C, whereas the others were at 20-23 degrees C for a period of 24 h. Core (Tc) and dorsal hand temperature decreased during surgery in both C and E (P less than 0.05) but not in W. After surgery, Tc increased similarly in C and E and by a smaller amount in W. Plasma catecholamine concentrations increased significantly in C and W but not in E (P less than 0.001), with the greatest response occurring in C. Postoperative oxygen consumption and carbon dioxide production exceeded preoperative values (P less than 0.01) in C but not in W or E. After surgery, plasma albumin fell and C-reactive protein increased similarly in all three groups. Thus body heat conservation or epidural blockade attenuates or abolishes the rise in plasma catecholamines and oxygen consumption postoperatively but does not prevent the increase in Tc or the acute phase protein response.
在全身麻醉下接受结肠手术的三组患者（对照组（C）、保温组（W）和硬膜外组（E），硬膜外组在手术期间及术后24小时在T4 - S5皮节接受局部麻醉）中，分别在手术前后测定体温、呼吸气体交换和血浆儿茶酚胺水平。手术结束时，W组患者在28 - 30摄氏度的环境温度下护理，而其他组在20 - 23摄氏度的环境温度下护理24小时。C组和E组患者在手术期间核心体温（Tc）和手背温度下降（P < 0.05），而W组未下降。术后，C组和E组的Tc升高幅度相似，W组升高幅度较小。C组和W组血浆儿茶酚胺浓度显著升高，E组未升高（P < 0.001），C组反应最为明显。C组术后氧耗量和二氧化碳产生量超过术前值（P < 0.01），W组和E组未出现这种情况。术后，三组患者血浆白蛋白均下降，C反应蛋白均升高。因此，体温保持或硬膜外阻滞可减轻或消除术后血浆儿茶酚胺升高和氧耗增加，但不能防止Tc升高或急性期蛋白反应。
