Stelzner J, Reinhart K, Föhring U, Henneberg M, Schäfer M, Fitzner R
Klinik für Anaesthesiologie und operative Intensivmedizin, Freien Universität Berlin.
Reg Anaesth. 1988 Jan;11(1):16-20.
It has been shown that the stress response to lower abdominal surgery can be inhibited by epidural analgesia (EA). But EA seems to have little influence on the stress reaction to major abdominal surgery. The purpose of our study was to find out whether EA is able to diminish the cortisol and glucose response to major transabdominal surgery.
31 patients undergoing elective surgery of the abdominal aorta were subdivided at random into 3 different anaesthesia groups: 1. halothane anesthesia, 2. neuroleptanalgesia (NLA) and 3. thoracic EA with bupivacaine (0.5%) in combination with a light general anesthesia. Some patients of each group received an intravenous infusion of 5% glucose. Blood samples were drawn before anesthesia, after intubation, 5 times during surgery and at the end of the operation and were analysed for cortisol and glucose. During the early postoperative period, 1, 2 and 24 h after surgery, only cortisol was measured.
Only the glucose levels of patients who received no carbohydrate-containing infusion fluids were used for evaluation of the stress response. In the halothane group, there was a significant increase of the mean cortisol and glucose levels after the start of surgery. No intraoperative elevations of blood glucose and cortisol were seen in the EA group. Patients of the NLA group showed no hyperglycaemia and only mild elevations of the cortisol levels during the intraoperative period.(ABSTRACT TRUNCATED AT 250 WORDS)
已有研究表明，硬膜外镇痛（EA）可抑制下腹部手术的应激反应。但EA似乎对腹部大手术的应激反应影响不大。我们研究的目的是确定EA是否能够减轻经腹大手术时皮质醇和葡萄糖的反应。
31例行腹主动脉择期手术的患者被随机分为3个不同的麻醉组：1. 氟烷麻醉；2. 神经安定镇痛（NLA）；3. 布比卡因（0.5%）胸段EA联合浅全身麻醉。每组部分患者接受5%葡萄糖静脉输注。在麻醉前、插管后、手术期间5次以及手术结束时采集血样，分析皮质醇和葡萄糖水平。在术后早期，即术后1、2和24小时，仅测定皮质醇。
仅将未接受含碳水化合物输注液患者的葡萄糖水平用于评估应激反应。在氟烷组，手术开始后平均皮质醇和葡萄糖水平显著升高。EA组术中未出现血糖和皮质醇升高。NLA组患者术中未出现高血糖，仅皮质醇水平轻度升高。（摘要截断于250字）
