Poon K S, Chang W K, Chen Y C, Chan K H, Lee T Y
Department of Anesthesiology, Veterans General Hospital-Taipei, Taiwan, R.O.C.
Acta Anaesthesiol Sin. 1995 Jun;33(2):85-90.
Each type of anesthesia has varying influence on the amount of catecholamine secretion during surgery. Epidural or spinal anesthesia can markedly suppress the increase of many of the stress hormones. Our purpose of this study is to evaluate metabolism change during surgery under anesthesia and to see whether general anesthesia combined with intraspinal anesthetic and narcotic is a better way to suppress such stress response.
Seventeen patients in fit physical condition (ASA class I) with normal biochemical screening scheduled for radical gastrectomy were studied. All patients were premedicated with diazepam and glycopyrrolate and an indwelling catheter was inserted into a radial artery under local anesthesia for monitoring blood pressure and obtaining blood samples for glucose and hormonal assays. A CVP line was set up via the right internal jugular vein for the administration of fluid (free of sugar). In the study group, a 32-G intraspinal catheter was placed via lumbar interspaces. Spinal blockade up to T4 by titrating 0.25% marcaine. Then anesthesia in both groups was induced with thiopental 5 mg/kg, followed by succinylcholine 1.5 mg/kg for intubation. Anesthesia was maintained with isoflurane, N2O, O2 and pancuronium. Blood samples for measurement cortisol, catecholamine and sugar were taken after induction and 30 min after surgical incision. Thirty min after skin incision all patients were subjected to glucose tolerance test, accomplished by giving 50% dextrose at 0.33 g/kg in 3 min. Arterial blood samples were then obtained at 1, 3, 5, 7, 10, 20, 30, 45 and 60 min intervals for plasma glucose determination.
No difference was evident in cortisol values, baseline, before and after surgical incision (p > 0.05) either intragroup or inter-group. Catecholamine and glucose were significantly higher in control group after surgical incision (p < 0.05, intra-gr and inter-gr). Following a glucose load the decay of plasma glucose was similar in both groups but glycemic level was higher in the control group.
Better control of stress response by general anesthesia combined with subarachnoid block was disclosed in this study.
每种麻醉方式在手术过程中对儿茶酚胺分泌量的影响各不相同。硬膜外或脊髓麻醉可显著抑制多种应激激素的增加。本研究的目的是评估麻醉下手术期间的代谢变化，并观察全身麻醉联合脊髓内麻醉和麻醉剂是否是抑制这种应激反应的更好方法。
对17例计划行根治性胃切除术、身体状况良好（ASA I级）且生化筛查正常的患者进行研究。所有患者术前均用安定和格隆溴铵预处理，并在局部麻醉下经桡动脉插入留置导管，用于监测血压并采集血样进行血糖和激素检测。通过右颈内静脉建立中心静脉压（CVP）管路用于补液（无糖）。在研究组中，经腰椎间隙置入一根32G的脊髓导管。通过滴定0.25%的布比卡因使脊髓阻滞达到T4水平。然后两组均用硫喷妥钠5mg/kg诱导麻醉，随后用琥珀酰胆碱1.5mg/kg进行插管。用异氟醚、N2O、O2和泮库溴铵维持麻醉。诱导后及手术切口后30分钟采集血样测定皮质醇、儿茶酚胺和血糖。皮肤切口后30分钟，所有患者均接受葡萄糖耐量试验，方法是在3分钟内给予0.33g/kg的50%葡萄糖。然后每隔1、3、5、7、10、20、30、45和60分钟采集动脉血样测定血浆葡萄糖。
无论是组内还是组间，手术切口前后的皮质醇值、基线值均无明显差异（p>0.05）。手术切口后对照组的儿茶酚胺和葡萄糖显著升高（组内和组间p<0.05）。给予葡萄糖负荷后，两组血浆葡萄糖的下降情况相似，但对照组的血糖水平更高。
本研究表明全身麻醉联合蛛网膜下腔阻滞能更好地控制应激反应。
