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1、上海交通大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)JournalofShanghaiJiaotongUniversity(MedicalScience)1681[文章編號(hào)]1674—8115(2013)12—1681—03·短篇論著·兩種不同麻醉方式對(duì)患者圍手術(shù)期應(yīng)激的影響仲勇，周嘉，袁嵐(上海中醫(yī)藥大學(xué)附屬曙光醫(yī)院麻醉科，上海201203)[摘要]目的探討兩種不同麻醉方式對(duì)患者圍手術(shù)期應(yīng)激的影響。方法按配對(duì)設(shè)計(jì)原則選擇腹部手術(shù)治療的患者62例，分為單純?nèi)砺樽斫M(A組)和全身麻醉復(fù)合硬膜外阻滯組(B組)，每組31例，分別于麻醉誘導(dǎo)前(T，)、手術(shù)開(kāi)始后30rain(
2、T)、關(guān)腹后(T)和術(shù)后24h(T)，記錄患者心率、平均動(dòng)脈血壓(MABP)，測(cè)血漿去甲腎上腺素(NE)、血清皮質(zhì)醇(Cot)和血清c反應(yīng)蛋白(CRP)濃度。術(shù)后記錄患者手術(shù)時(shí)間及出血量。結(jié)果兩組患者手術(shù)時(shí)間和出血量比較差異均無(wú)統(tǒng)計(jì)學(xué)意義(P>0．05)；T、T和T時(shí)間點(diǎn)，B組患者M(jìn)ABP均低于A組患者(P<0．05)，T時(shí)兩組患者M(jìn)ABP比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0．05)；T，～T各時(shí)間點(diǎn)兩組患者心率比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0．05)；T。時(shí)間點(diǎn)，B組NE水平明顯高于A組(P<0．01)，但兩組問(wèn)Cor、CRP比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0
3、．05)；T、T、T時(shí)間點(diǎn)，B組NE、Cor和CRP水平均顯著低于A組(P<0．01或P<0．05)。結(jié)論全身麻醉復(fù)合硬膜外阻滯較單純?nèi)砺樽砀芙档突颊邍中g(shù)期應(yīng)激反應(yīng)。[關(guān)鍵詞]全身麻醉；硬膜外阻滯；去甲腎上腺素；皮質(zhì)醇；C反應(yīng)蛋白[DOI]10．3969／j．issn．1674—8115．2013+12．027[中圖分類號(hào)]R614．2；R614．42[文獻(xiàn)標(biāo)志碼]BStressinperioperativeperiodoftwodifferentanesthesiamethodsZHONGYong，ZHOUJia，YUANLan(Dep
4、artmentofAnesthesiology，ShuguangHospital，ShanghaiUniversityofTraditionalChineseMedicine，Shanghai201203China)【Abstract】ObjectiveToexplorestressinperioperativeperiodoftwodifferentanesthesiamethods．MethodsAccordingtomatchingdesign，62patientsunderwentabdominalsurgerywereselected
5、anddividedintogeneralanesthesiagroup(groupA)andgeneralanesthesiacombinedwithepiduralblockgroup(groupB)with31ineach．Heartrate(HR)，meanarterialbloodpressure(MABP)，plasmanorepinephrine(NE)，serumcortisol(Cor)，andserumC—reactiveprotein(CPR)concentrationweremeasuredinthebeginningo
6、fanesthesia(T1)，30minafterbeginning(T2)，abdominalsuture(T)，and24hafteroperation(T4)．Operationtimeandamountofbleedingwererecorded．ResultsTherewere1osignificantdifferencesofoperationtimeandbleedingbetweenthetwogroups(尸>0．05)．ComparedtogroupA，MABPvaluesweresignificantlylowerinp
7、atientsofgroupBinT1，T2，andT3timepoints(P<0．05)，butMABPvaluesweresimilarinTd(P>0．05)．TheHRvalueswerenormalinbothgroups．InTl，theNElevelsofBgroupweresignificantlyhigher(P<0．01)，buttherewerenosignificantdifferencesofCorandCRPvalues．InT2，T3，andT4timepoints，theNE，Cor，andCRPvaluesw
8、eresignificantlyloweringroupBthanthoseofgroupA(P<0．05，P<0．o1)．ConclusionGen
