Namba Y, Smith J B, Fox G S, Challis J R
Br J Anaesth. 1980 Oct;52(10):1027-32. doi: 10.1093/bja/52.10.1027.
The effects of extradural and general anaesthesia on the adrenocortical response to elective or emergency Caesarean section were studied in 72 patients. Maternal plasma concentrations of cortisol were measured before surgery, at delivery, and 30 and 60 min after skin incision. Umbilical vein and artery plasma cortisol concentrations at delivery were determined also. Maternal plasma cortisol concentrations in patients receiving extradural anaesthesia did not change significantly from control at any of the time intervals. In the general anaesthesia group concentrations were significantly increased from control, at 30 and 60 min after skin incision for elective Caesarean sections, and at 60 min after skin incision during emergency surgery. There were no significant differences between the mean umbilical vein and artery plasma cortisol concentrations compared within or between extradural or general anaesthesia groups. Extradural anaesthesia, in contrast to general anaesthesia, decreases the adrenocortical response to Caesarean section surgery by blocking afferent neurogenic pathways from the surgical site. The method of anaesthesia does not influence the fetal cortisol response.
对72例患者研究了硬膜外麻醉和全身麻醉对选择性或急诊剖宫产肾上腺皮质反应的影响。在手术前、分娩时以及皮肤切开后30分钟和60分钟测量母体血浆皮质醇浓度。还测定了分娩时脐静脉和动脉血浆皮质醇浓度。接受硬膜外麻醉患者的母体血浆皮质醇浓度在任何时间间隔均与对照组相比无显著变化。在全身麻醉组中，对于择期剖宫产，在皮肤切开后30分钟和60分钟，以及急诊手术期间皮肤切开后60分钟，浓度较对照组显著升高。硬膜外或全身麻醉组内或组间比较，脐静脉和动脉血浆皮质醇平均浓度无显著差异。与全身麻醉相比，硬膜外麻醉通过阻断来自手术部位的传入神经通路，降低了剖宫产手术的肾上腺皮质反应。麻醉方法不影响胎儿皮质醇反应。
