Caba F, Echevarría M, Guerrero J M, Rodríguez R
Servicio de Anestesiología-Reanimación, Hospital Universitario de Valme, Sevilla.
Rev Esp Anestesiol Reanim. 1995 Nov;42(9):364-8.
To study neuroendocrine response during cholecystectomy under general anesthesia with fentanyl and under general anesthesia with nitrous oxide plus thoracic epidural block, by determining plasma levels of ACTH and beta-endorphin.
This was a prospective study of 2 randomly chosen groups of 7 patients each who were undergoing cholecystectomy. One group received general anesthesia with fentanyl at initial doses of 10 micrograms/kg-1 followed by perfusion of 5 micrograms.kg-1.h-1. The other group received general anesthesia with 60% nitrous oxide in oxygen combined with bupivacaine 0.5% for thoracic epidural blockade. Plasma levels of ACTH and beta-endorphin were determined at the following moments: A, upon arrival in the operating theater; B, after anesthetic induction and intubation; C, after incision; D, 30 minutes after start of surgery; E, after surgery but before extubation, and F, after arrival in the recovery room. Also recorded were mean arterial pressure and heart rate.
In both groups we found significantly higher levels of beta-endorphin throughout surgery. The increase was greater, however, in the group receiving combined anesthesia at moments D (p = 0.008) and E (p = 0.008). ACTH levels rose significantly during surgery (p = 0.004) in the combined anesthesia group, whereas there was only a slight increase in the group receiving only general anesthesia (p = NS). beta-endorphin levels increased proportionally more than ACTH levels during combined anesthesia. Hemodynamic stability was acceptable in both groups.
General anesthesia with fentanyl at the dose used in this study was more effective that combined anesthesia in mitigating the release of ACTH and beta-endorphin during cholecystectomy.
通过测定促肾上腺皮质激素（ACTH）和β-内啡肽的血浆水平，研究芬太尼全身麻醉及氧化亚氮加胸段硬膜外阻滞全身麻醉下胆囊切除术期间的神经内分泌反应。
这是一项前瞻性研究，将随机选择的两组患者（每组7例）纳入其中，这些患者均接受胆囊切除术。一组接受芬太尼全身麻醉，初始剂量为10微克/千克，随后以5微克·千克⁻¹·小时⁻¹的速度输注。另一组接受60%氧化亚氮与氧气混合的全身麻醉，并联合0.5%布比卡因进行胸段硬膜外阻滞。在以下时间点测定ACTH和β-内啡肽的血浆水平：A，到达手术室时；B，麻醉诱导和插管后；C，切开后；D，手术开始后30分钟；E，手术后但拔管前；F，到达恢复室后。同时记录平均动脉压和心率。
两组在整个手术过程中β-内啡肽水平均显著升高。然而，在D（p = 0.008）和E（p = 0.008）时刻，联合麻醉组的升高幅度更大。联合麻醉组手术期间ACTH水平显著升高（p = 0.004），而仅接受全身麻醉的组仅有轻微升高（p = 无统计学意义）。联合麻醉期间，β-内啡肽水平的升高比例大于ACTH水平。两组的血流动力学稳定性均可接受。
本研究中使用的芬太尼全身麻醉在减轻胆囊切除术期间ACTH和β-内啡肽的释放方面比联合麻醉更有效。
