Vedrinne C, Vedrinne J M, Guiraud M, Patricot M C, Bouletreau P
Department of Anaesthesiology and Intensive Care, Hôtel Dieu, Lyon, France.
Anesth Analg. 1989 Sep;69(3):354-9.
A nitrogen-sparing effect of epidural anesthesia has been clearly demonstrated in gynecological and lower abdominal surgery. To determine if epidural anesthesia also has a protein-sparing effect during major upper or mid-abdominal surgery, postoperative nitrogen balance and 3-methylhistidine urinary excretion (an index of skeletal muscle protein catabolism) were measured for 6 days in 28 patients who had undergone colon resection for cancer with general anesthesia (N2O-O2-1% enflurane) either supplemented with low dose fentanyl plus intermittent systemic pentazocine for postoperative pain (n = 13), or the same general anesthetic plus epidural injection of either etidocaine 1% intraoperatively and bupivacaine 0.25% postoperatively (n = 8) or meperidine (n = 7) for 48 hr after skin incision. The cumulative 6-day nitrogen balance and the cumulative 3-methylhistidine urinary excretion were significantly less after epidural injection of etidocaine intraoperatively and bupivacaine postoperatively than in the two other groups. There was a significant correlation between the daily urinary excretion of 3-methylhistidine and the daily nitrogen balance in the three groups. This study suggests that in colon surgery, epidural analgesia with local anesthetics in the postoperative period improves nitrogen balance and this effect takes place partly in the muscle.
硬膜外麻醉的氮节省效应已在妇科和下腹部手术中得到明确证实。为确定硬膜外麻醉在中上腹部大手术期间是否也具有蛋白质节省效应，对28例因癌症接受结肠切除术并采用全身麻醉（N2O - O2 - 1%安氟醚）的患者进行了为期6天的术后氮平衡和3 - 甲基组氨酸尿排泄量（骨骼肌蛋白分解代谢指标）测量。这些患者中，13例在术后疼痛时采用低剂量芬太尼加间歇性静脉注射喷他佐辛辅助全身麻醉，8例在术中注射1%依替卡因、术后注射0.25%布比卡因辅助相同的全身麻醉，7例在皮肤切口后48小时采用相同的全身麻醉加硬膜外注射哌替啶。术中注射依替卡因并术后注射布比卡因的患者，其6天累计氮平衡和3 - 甲基组氨酸累计尿排泄量显著低于其他两组。三组中，3 - 甲基组氨酸每日尿排泄量与每日氮平衡之间存在显著相关性。本研究表明，在结肠手术中，术后采用局部麻醉药进行硬膜外镇痛可改善氮平衡，且这种效应部分发生在肌肉中。
