Çeliksular M Cem, Saraçoğlu Ayten, Yentür Ercüment
Department of Anaesthesiology and Reanimation, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey.
Department of Anaesthesiology Aad Reanimation, İstanbul Bilim University School of Medicine, İstanbul, Turkey.
Turk J Anaesthesiol Reanim. 2016 Jun;44(3):117-23. doi: 10.5152/TJAR.2016.65265. Epub 2016 Jun 1.
The effects of oral carbohydrate solutions, ingested 2 h prior to operation, on stress response were studied in patients undergoing general or epidural anaesthesia.
The study was performed on 80 ASA I-II adult patients undergoing elective total hip replacement, which were randomized to four groups (n=20). Group G patients undergoing general anaesthesia fasted for 8 h preoperatively; Group GN patients undergoing general anaesthesia drank oral carbohydrate solutions preoperatively; Group E patients undergoing epidural anaesthesia fasted for 8 h and Group EN patients undergoing epidural anaesthesia drank oral carbohydrate solutions preoperatively. Groups GN and EN drank 800 mL of 12.5% oral carbohydrate solution at 24:00 preoperatively and 400 mL 2 h before the operation. Blood samples were taken for measurements of glucose, insulin, cortisol and IL-6 levels.
The effect of preoperative oral carbohydrate ingestion on blood glucose levels was not significant. Insulin levels 24 h prior to surgery were similar; however, insulin levels measured just before surgery were 2-3 times higher in groups GN and EN than in groups G and E. Insulin levels at the 24(th) postoperative hour in epidural groups were increased compared to those at basal levels, although general anaesthesia groups showed a decrease. From these measurements, only the change in Group EN was statistically significant (p<0.05). Plasma cortisol levels at the 2(nd) peroperative hour were higher in epidural groups than in general anaesthesia groups. Both anaesthesia techniques did not have an effect on IL-6 levels.
We concluded that epidural anaesthesia suppressed stress response, although preoperative oral carbohydrate nutrition did not reveal a significant effect on surgical stress response.
研究术前2小时口服碳水化合物溶液对接受全身麻醉或硬膜外麻醉患者应激反应的影响。
本研究纳入80例拟行择期全髋关节置换术的ASA I-II级成年患者，随机分为四组（每组n = 20）。G组患者接受全身麻醉，术前禁食8小时；GN组患者接受全身麻醉，术前饮用口服碳水化合物溶液；E组患者接受硬膜外麻醉，术前禁食8小时；EN组患者接受硬膜外麻醉，术前饮用口服碳水化合物溶液。GN组和EN组在术前24:00饮用800 mL 12.5%的口服碳水化合物溶液，术前2小时饮用400 mL。采集血样测定血糖、胰岛素、皮质醇和IL-6水平。
术前口服碳水化合物对血糖水平的影响不显著。术前24小时胰岛素水平相似；然而，术前即刻测量的胰岛素水平在GN组和EN组比G组和E组高2 - 3倍。硬膜外麻醉组术后第24小时胰岛素水平较基础水平升高，而全身麻醉组则降低。从这些测量结果来看，只有EN组的变化具有统计学意义（p<0.05）。术中第2小时硬膜外麻醉组血浆皮质醇水平高于全身麻醉组。两种麻醉技术对IL-6水平均无影响。
我们得出结论，硬膜外麻醉可抑制应激反应，尽管术前口服碳水化合物营养对手术应激反应未显示出显著影响。
