Carli F, Kulkarni P, Webster J D, MacDonald I A
Department of Anaesthesia, Northwick Park Hospital, Middlesex, England.
Acta Anaesthesiol Scand. 1995 Nov;39(8):1041-7. doi: 10.1111/j.1399-6576.1995.tb04226.x.
Core (aural canal) and mean skin (15 sites) temperatures, plasma adrenaline, noradrenaline and metabolites, and gaseous exchange were measured before, during and for 4 h after surgery in sixteen patients scheduled for elective colorectal surgery. All patients received general anaesthesia and no measures were taken to prevent the perioperative loss of body heat. At time of abdominal wall closure, when the core temperature was below 35.0 degrees C, the patients were randomly allocated to receive either 20-30 mg of papaveretum i.v. (papaveretum group, n = 8) or 15 ml of bupivacaine 0.75% via thoracic (T9) epidural route to obtain a T4-S5 sensory blockade (epidural group, n = 8). Continuous infusion of either i.v. papaveretum or epidural 0.25% bupivacaine was continued after surgery. During the recovery period of four hours the rate of increase in core and mean skin temperatures was significantly slower in the epidural group compared with the papaveretum group (P < 0.01). Plasma catecholamine concentrations remained elevated after surgery in the papaveretum group, whilst they decreased significantly once epidural blockade was established (P < 0.001). There was a lower trend, however not significant, in the rise of postoperative oxygen consumption and plasma glucose concentration in the epidural group compared with the papaveretum group.
对16例择期行结直肠手术的患者，在手术前、手术期间及术后4小时测量其核心温度（耳道温度）和平均皮肤温度（15个部位）、血浆肾上腺素、去甲肾上腺素及其代谢产物，以及气体交换情况。所有患者均接受全身麻醉，未采取任何措施预防围手术期体温散失。在腹壁关闭时，当核心温度低于35.0℃时，将患者随机分为两组，一组静脉注射20 - 30mg罂粟碱（罂粟碱组，n = 8），另一组通过胸段（T9）硬膜外途径注射15ml 0.75%布比卡因以获得T4 - S5感觉阻滞（硬膜外组，n = 8）。术后继续静脉输注罂粟碱或硬膜外输注0.25%布比卡因。在4小时的恢复期内，硬膜外组核心温度和平均皮肤温度的升高速率明显慢于罂粟碱组（P < 0.01）。罂粟碱组术后血浆儿茶酚胺浓度仍保持升高，而一旦建立硬膜外阻滞，其浓度则显著下降（P < 0.001）。与罂粟碱组相比，硬膜外组术后氧耗量和血浆葡萄糖浓度升高的趋势较低，但无统计学意义。
