Brandt M R, Fernades A, Mordhorst R, Kehlet H
Br Med J. 1978 Apr 29;1(6120):1106-8. doi: 10.1136/bmj.1.6120.1106.
Postoperative nitrogen balance was monitored in twelve patients undergoing hysterectomy under either epidural analgesia or general anaesthesia. The mean cumulative five-day nitrogen losses were significantly lower after epidural analgesia than after general anaesthesia. Nitrogen sparing presumably results from inhibiting the stress-induced release of catabolic hormones, since epidural analgesia abolished postoperative hyperglycaemia and increase in plasma cortisol concentrations. No adverse effects of inhibiting the stress response were observed. Neurogenic stimuli thus play a crucial part in the catabolic response to surgery. Inhibiting the endocrine metabolic response to trauma by neurogenic blockade may reduce the morbidity precipitated in high-risk patients by the catabolic response to surgery.
对12例行子宫切除术的患者在硬膜外镇痛或全身麻醉下监测术后氮平衡。硬膜外镇痛后的平均累积五日氮损失显著低于全身麻醉后。氮的节省可能是由于抑制了应激诱导的分解代谢激素的释放，因为硬膜外镇痛消除了术后高血糖和血浆皮质醇浓度的升高。未观察到抑制应激反应的不良反应。因此，神经源性刺激在手术的分解代谢反应中起关键作用。通过神经源性阻滞抑制对创伤的内分泌代谢反应，可能会降低高危患者因手术的分解代谢反应而引发的发病率。
