Engquist A, Brandt M R, Fernandes A, Kehlet H
Acta Anaesthesiol Scand. 1977;21(4):330-5. doi: 10.1111/j.1399-6576.1977.tb01227.x.
The adrenocortical and hyperglycemic responses to hysterectomy were studied in five groups of patients receiving: general anesthesia (group I), general anesthesia + epidural analgesia extending from Th10-S5 (group II), general anesthesia + epidural analgesia extending from Th8-S4--5 (group III), general anesthesia + epidural analgesia extending from Th4--6-S5 (group IV) and epidural analgesia extending from Th4-S5 without general anesthesia (group V). The results showed that the cortisol response was abolished in group V, inhibited in group IV and normal in groups II and III. The hyperglycemic response to surgery was inhibited in groups II, III and IV, and abolished in group V. Epidural analgesia from Th4 to S5, preventing the adrenocortical and hyperglycemic responses to hysterectomy, and possibly also inhibiting other components of the endocrine-metabolic response to surgery, may have important applications in further studies of the physiologic significance of the endocrine-metabolic response to surgery.
全身麻醉（第一组）、全身麻醉+从胸10至骶5的硬膜外镇痛（第二组）、全身麻醉+从胸8至骶4-5的硬膜外镇痛（第三组）、全身麻醉+从胸4-6至骶5的硬膜外镇痛（第四组）以及无全身麻醉的从胸4至骶5的硬膜外镇痛（第五组）。结果显示，第五组的皮质醇反应消失，第四组受到抑制，第二组和第三组正常。手术引起的高血糖反应在第二组、第三组和第四组受到抑制，在第五组消失。从胸4至骶5的硬膜外镇痛可防止子宫切除术后的肾上腺皮质和高血糖反应，并且可能还抑制手术内分泌-代谢反应的其他成分，这可能在进一步研究手术内分泌-代谢反应的生理意义中有重要应用。
