Evaluation of Stress Response to Surgery under General Anesthesia Combined with Spinal Analgesia

全身麻醉合併蜘蛛網膜腔內局部麻醉劑對手術中新陳代謝之影響

潘健成(Kin-Shing Poon) ； 張文貴(Wen-Kuei Chang) ； 陳永忠(Yung-Chung Chen) ； 陳國瀚(Kwok-Hon Chan) ； 李德譽(Tak-Yu Lee)

《Acta Anaesthesiologica Sinica》 33卷2期 (1995/06) Pp. 85-90

摘要

Background: Each type of anesthesia has varying influence on the amount of catecholamine secretion during surgery. Epidural or spinal anesthesia can markedly suppress the increase of many of the stress hormones. Our purpose of this study is to evaluate metabolism change during surgery under anesthesia and to see whether general anesthesia combined with intraspinal anesthetic and narcotic is a better way to suppress such stress response. Methods: Seventeen patients in fit physical condition (ASA class I) with normal biochemical screening scheduled for radical gastrectomy were studied. All patients were premedicated with diazepam and glycopyrrolate and an indwelling catheter was inserted into a radial artery under local anesthesia for monitoring blood pressure and obtaining blood samples for glucose and hormonal assays. A CVP line was set up via the right internal jugular vein for the administration of fluid (free of sugar). In the study group, a 32-G intraspinal catheter was placed via lumbar interspaces. Spinal blockade up to T_4 by titrating 0.25 % marcaine. Then anesthesia in both groups was induced with thiopental 5 mg/kg, followed by succinylcholine 1.5 mg/kg for intubation. Anesthesia was maintained with isoflurane, N_2O, O_2 and pancuronium. Blood samples for measurement cortisol, catecholamine and sugar were taken after induction and 30 min after surgical incision. Thirty min after skin incision all patients were subjected to glucose tolerance test, accomplished by giving 50% dextrose at 0.33 g/kg in 3 min. Arterial blood samples were then obtained at 1, 3, 5, 7, 10, 20, 30, 45 and 60 min intervals for plasma glucose determination. Results: No difference was evident in cortisol values, baseline, before and after surgical incision (p＞ 0.05) either intra-group or inter-group. Catecholamine and glucose were significantly higher in control group after surgical incision (p ＜ 0.05, intra-gr and inter-gr). Following a glucose load the decay of plasma glucose was similar in both groups but glycemic level was higher in the control group. Conclusions: Better control of stress response by general anesthesia combined with subarachnoid block was disclosed in this study.

關鍵字

Stress response ； Anesthesia: general, spinal

並列摘要

背景：手術中病人之血糖、cortisol及catecholamine等均上升，如要設法使病人在手術中維持一平穩之生理狀態，單純全身麻醉可能未克完全達成任務。國外已經有若干文獻對全身麻醉及區域麻醉分別作新陳代謝的評估，我們則併用兩種方法來評估其效益。方法：選擇17位ASA class I行上腹部手術之病人分作兩組，於麻醉前均放置動脈及中央靜脈導管，抽取動脈血樣本作為血糖、cortisol及catecholamine基礎值。實驗組病人放置32號intraspinal catheter並以0.25% bupivacaine將神經阻斷至T_4之後兩組病人均以thiopental 5 mg/kg及succinylcholine 1.5 mg/kg行全身麻醉誘導，以isoflurane，N_2O, O_2，及pancuronium作麻醉維持。於麻醉誘導後及下刀後30 min各抽取血樣本測血糖、cortisol及catecholamine，又在下刀30 min後兩組病人均以dextrose 0.33g/kg靜注作血糖耐受測試。Dextrose注射後之1，3，5，7，10，20，30，45，60 min各抽取血樣本作血糖分析。病人於術後均以0.1 mg morphine經intraspinal作疼痛控制。實驗全程中所用之靜注液體均不含糖分。結果：在cortisol方面兩組病人沒有統計上之差異，但epinephrine、norepinephrine及blood sugar方面則在下刀後30 min兩組有明顯之差異（p＜0.05）。控制組比實驗組偏高：血糖（109.5 ± 12.1 vs. 86.3 ± 8.9 mg/dl）；epinephrine（144.8 ± 107.9 vs. 34.9 ± 30.1 pg/ml）；norepinephrine（440.8 ± 69.2 vs. 256.8 ± 93.4 pg/ml）。在血糖耐受測試中控制組之血糖值在全程中均比實驗組為高。結論：在本實驗中全身麻醉合併蜘蛛網膜腔內局部麻醉劑確能更有效控制病人對stress之反應，新陳代謝亦更趨平穩。

並列關鍵字

Stress反應 ； 麻醉：全身，半身