Carli F, Webster J, Pearson M, Pearson J, Bartlett S, Bannister P, Halliday D
Department of Anaesthesia, Northwick Park Hospital, Harrow, Middlesex.
Br J Anaesth. 1991 Dec;67(6):729-34. doi: 10.1093/bja/67.6.729.
We have studied the effect of intraoperative and postoperative (24 h) extradural block with local anaesthetic on whole body protein turnover (stable isotope methodology) and urinary excretion of urea nitrogen, adrenaline, noradrenaline and cortisol in a group of well nourished elderly patients undergoing colorectal surgery who received a constant nutritional intake before (7 days) and after (4 days) surgery. One group (control, n = 8) received routine anaesthetic and surgical care. Patients in the test group (extradural, n = 9) received extradural bupivacaine, and sensory block (T4-S5) was maintained during and after surgery for a period of 24 h. Whole body protein breakdown and amino acid oxidation increased significantly after surgery in both groups (P less than 0.05), but the increase in protein breakdown in the extradural group was significantly less than that in the control group. Urinary excretion of urea nitrogen, adrenaline and noradrenaline increased in the control group after surgery, whilst the increase in the extradural group was very small. In contrast, urinary excretion of cortisol increased significantly in both groups after surgery. We conclude that extradural block maintained for 24 h after surgery significantly minimized postoperative protein breakdown without compromising whole body protein synthesis.
我们研究了术中及术后（24小时）局部麻醉药硬膜外阻滞对一组营养状况良好、在手术前（7天）和手术后（4天）接受恒定营养摄入的老年结直肠手术患者全身蛋白质周转（稳定同位素方法）以及尿素氮、肾上腺素、去甲肾上腺素和皮质醇尿排泄的影响。一组（对照组，n = 8）接受常规麻醉和手术护理。试验组（硬膜外组，n = 9）患者接受硬膜外布比卡因，术中及术后24小时维持感觉阻滞（T4 - S5）。两组患者术后全身蛋白质分解和氨基酸氧化均显著增加（P < 0.05），但硬膜外组蛋白质分解的增加显著低于对照组。对照组术后尿素氮、肾上腺素和去甲肾上腺素的尿排泄增加，而硬膜外组的增加非常小。相反，两组患者术后皮质醇的尿排泄均显著增加。我们得出结论，术后维持24小时的硬膜外阻滞可显著减少术后蛋白质分解，而不影响全身蛋白质合成。
