Licker M, Suter P M, Krauer F, Rifat N K
Department of Anaesthesiology, Geneva University Hospital, Switzerland.
Eur J Anaesthesiol. 1994 May;11(3):193-9.
To determine whether the type of peri-operative analgesic regimen affects the metabolic response during and after surgery, we studied 19 women undergoing abdominal hysterectomy under propofol anaesthesia. Patients were randomized to receive either continuous intravenous opioid or a bupivacaine-opioid mixture through a lumbar epidural catheter. Total body oxygen consumption and carbon dioxide excretion, blood glucose and haemodynamic variables were determined up to 24 h after surgery. No differences in any metabolic or haemodynamic variables were noted during surgery. In the post-operative period, the increase in oxygen consumption up to pre-operative values, the urinary nitrogen excretion and the changes in acute phase proteins were similar in both treatment groups. In contrast, the respiratory quotient was significantly higher in the lumbar epidural group than in the intravenous opioid group, 0.87 (SD 0.04) vs 0.77 (SD 0.06) (P < 0.05) and the hyperglycaemic response was more delayed in the epidural group. These data suggest that prolonged sympathetic blockade associated with epidural analgesia might contribute to better preservation of glucose homeostasis in the perioperative period.
为了确定围手术期镇痛方案的类型是否会影响手术期间及术后的代谢反应，我们研究了19例在丙泊酚麻醉下接受腹部子宫切除术的女性患者。患者被随机分为两组，一组通过腰椎硬膜外导管持续静脉输注阿片类药物，另一组接受布比卡因 - 阿片类药物混合物。在术后24小时内测定全身耗氧量、二氧化碳排出量、血糖和血流动力学变量。手术期间未观察到任何代谢或血流动力学变量的差异。在术后阶段，两个治疗组中耗氧量增加至术前值、尿氮排泄以及急性期蛋白的变化相似。相比之下，腰椎硬膜外组的呼吸商显著高于静脉阿片类药物组，分别为0.87（标准差0.04）和0.77（标准差0.06）（P < 0.05），并且硬膜外组的高血糖反应延迟更明显。这些数据表明，与硬膜外镇痛相关的交感神经阻滞延长可能有助于在围手术期更好地维持葡萄糖稳态。
