程殿臣 杨瑞青

[摘要] 目的：探讨腰麻和硬膜外麻醉对子宫次全切患者血浆心钠素及应激反应物质的影响。方法：40例行子宫次全切患者，随机分为腰麻组（SA，n=20），硬膜外麻醉组（EA，n=20）。两组分别于术前30 min、术毕、术后24 h采集肘静脉血各5 ml，检测各时间点血浆心钠素（ANP）、肾上腺素（AN）、皮质醇（CS）的浓度。结果：术前EA组与SA组两组间ANP、AN、CS比较差异无统计学意义（P＞0.05）。ANP的血浆浓度水平两组在术后24 h均比术前升高（P＜0.05）。EA组术毕时患者ANP 、AN、CS的浓度分别为（62.1±15.0）、（97.1±29.4）、（209.8±80.6）ng/L，明显低于SA组[（61.4±17.0）、（157.4±43.0）、（286.6±80.5）ng/L]的浓度水平（P＜0.05）；术后24 h患者ANP、AN、CS的浓度分别为（103.4±21.3）、（66.7±20.1）、（140.5±50.2）ng/L，明显低于SA组[（100.2±20.8）、（102.1±29.5）、（250.9±80.1）ng/L]的浓度水平（P＜0.05）。结论：EA+强化麻醉可提高机体应激反应效应和心血管反应，对患者术后恢复具有积极作用。

[关键词] 腰麻；硬膜外麻醉；心钠素；肾上腺素；皮质醇

[中图分类号] R614[文献标识码] A[文章编号]1673-7210（2011）11（c）-090-02

Effect of ANP and irritability respone in hysterectomy with different narcosis

CHENG Dianchen1, YANG Ruiqing2

1.Department of Anesthesia, Maternal and Child Health Hospital of Lanzhou City, Gansu Province, Lanzhou 730030, China; 2. Department of Gynecology, Maternal and Child Health Hospital of Lanzhou City, Gansu Province, Lanzhou 730030, China

[Abstract] Objective: To study the spinal and epidural anesthesia for hysterectomy patients with plasma atrial natriuretic peptide and cut the material impact of the stress response. Methods: Routine hysterectomy cut 40 patients were randomly divided into two groups, the spinal anesthesia group (SA, n=20), epidural anesthesia group (EA, n=20). Two groups respectively collected venous blood 5 ml before surgery 30 min, surgery over, after 24 h, tested each time point of plasma atrial natriuretic peptide (ANP), epinephrine (AN), and cortisol (CS) concentration. Results: Before surgery EA group and SA group ANP, AN, CS had no significant differences (P>0.05). The two groups ANP plasma levels 24 h after surgery was increased than those before surgery (P<0.05). EA group when surgery over the ANP, AN, CS concentrations [(62.1±15.0), (97.1±29.4), (209.8±80.6) ng/L] was significantly lower than the SA group [(61.4±17.0), (157.4±43.0), (286.6±80.5) ng/L] (P<0.05); 24 h after the patient plasma epinephrine ANP, AN, CS concentrations [(103.4±21.3), (66.7±20.1), (140.5±50.2) ng/L] was significantly lower than the SA group [(100.2±20.8), (102.1±29.5), (250.9±80.1) ng/L] (P<0.05). Conclusion: EA adding enhanced anesthesia can increase the effects of stress response and cardiovascular response, postoperative recovery of patients have a positive effect.

[Key words] Spinal anesthesia; Epidural anesthesia; ANP; Adrenaline; Cortisol

子宫次全切是妇科较为常见的手术，麻醉方法多选用硬膜外或腰麻。硬膜外、腰麻血流动力学的改变已有大量研究和报道，心钠素（ANP）在子宫次全切手术时应用硬膜外、腰麻不同麻醉方法中的改变尚未见报道。本研究对40例行子宫次全切患者分别采用蛛网膜下腔麻醉和硬膜外麻醉，观察两组患者术前、术毕及术后24 h血浆心钠素（ANP）、肾上腺素（AN）、皮质醇（CS）的浓度变化，观察两种不同麻醉方法对机体应激因素和心血管反应的影响。现将结果报道如下：

1资料与方法

1.1 一般资料

择期子宫次全切患者40例，年龄35~62岁，体重51~68 kg，ASA Ⅰ或Ⅱ级，无神经、内分泌和其他合并症。患者随机分为腰麻组（SA）和硬膜外麻醉组（EA）两组，每组各20例。两组患者年龄、体重、ASA分级及手术经过和手术时间差异无统计学意义（P＞0.05），均无麻醉及手术合并症。……