Hendolin H, Lahtinen J, Länsimies E, Tuppurainen T
Department of Anaesthesia, University Central Hospital, Kuopio, Finland.
Ann Chir Gynaecol. 1987;76(4):234-40.
A hundred patients scheduled for cholecystectomy were randomized to either thoracic epidural anaesthesia and analgesia for 24 h with bupivacaine intraoperatively about 100 mg and 15 mg/h thereafter (TEA) for postoperative analgesia, TEA combined with general anaesthesia (low dose fentanyl) (TEA + GA) and general anaesthesia (GA) (low dose fentanyl). During TEA and TEA + GA the arterial pressure was significantly decreased as compared with GA. TEA was associated by an intense haemodilution in comparison with GA. Blood glucose and plasma cortisol responses were significantly suppressed by TEA. The decreases in peripheral blood lymphocyte and eosinophilic counts observed after operation under GA was significantly reduced by TEA. The increase in the neutrophil count was inhibited by TEA but the increase in non-filamented neutrophils was significantly augmented by TEA. The postoperative alleviation of the alteration of the above mentioned parameters by TEA was slightly diminished in the TEA + GA group. However, we found no significant reduction in cardiac dysrhythmias (TEA 7%, TEA + GA 7% and GA 10%), ST-segment depression (TEA 17%), TEA + GA 3.3% and GA 12.5%), wound complication (TEA 3%, TEA + GA 0%, GA 0%), pneumonia (TEA 3%, TEA + GA 3% and GA 0%), subphrenic abscess (TEA 6%, TEA + GA 0%, GA 3%), mortality (TEA 0%, TEA + GA 3%, GA 0%), and urinary tract infect (TEA 17%, TEA + GA 7% and GA 2.5%). Since an equal number of patients in each group, about 30%, suffered one or more of the postoperative complications this epidural analgesia was not effective in reducing postoperative morbidity albeit the significant alleviation of the postoperative stress response.
一百例计划行胆囊切除术的患者被随机分为三组，分别接受以下处理：术中使用约100mg布比卡因行24小时胸段硬膜外麻醉和镇痛，术后以15mg/h持续给药（TEA组）；TEA联合全身麻醉（低剂量芬太尼）（TEA + GA组）；全身麻醉（GA组）（低剂量芬太尼）。与GA组相比，TEA组和TEA + GA组术中动脉压显著降低。与GA组相比，TEA组伴有明显的血液稀释。TEA可显著抑制血糖和血浆皮质醇反应。GA组术后外周血淋巴细胞和嗜酸性粒细胞计数下降，TEA可显著减轻这种下降。TEA可抑制中性粒细胞计数增加，但可显著增加非分叶中性粒细胞计数。TEA对上述参数术后变化的缓解作用在TEA + GA组略有减弱。然而，我们发现心律失常（TEA组7%，TEA + GA组7%，GA组10%）、ST段压低（TEA组17%，TEA + GA组3.3%，GA组12.5%）、伤口并发症（TEA组3%，TEA + GA组0%，GA组0%）、肺炎（TEA组3%，TEA + GA组3%，GA组0%）、膈下脓肿（TEA组6%，TEA + GA组0%，GA组3%）、死亡率（TEA组0%，TEA + GA组3%，GA组0%）和尿路感染（TEA组17%，TEA + GA组7%，GA组2.5%）均无显著降低。由于每组约30%的患者发生一种或多种术后并发症，尽管硬膜外镇痛可显著减轻术后应激反应，但对降低术后发病率无效。
