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1、海南医学2007年第18卷第10期文章编号!1003"6350#2007$10%015"03论著不同麻醉方法下行子宫切除时机体应激反应的比较12程翔!刘保江"1#山西医科大学第二医院麻醉科!山西太原030001$2#山西医科大学第一医院麻醉科!山西太原%摘要目的探讨行子宫切除时使机体应激反应最适度的一种麻醉方法方法选30~60岁入我院拟施子宫全切次全切的患者ASA!~"级共60例随机分配到四个组别A组选硬膜外阻滞B组选腰硬联合阻滞C组选用异丙酚靶控输注插管全麻D组选用全麻复合硬膜外阻滞各组在麻醉前麻醉后5min切开腹膜时切除子宫时术毕五个时间点测下列指标肾素血管紧张素"醛固酮皮质醇胰岛素血
2、糖生长素同时监测患者的血流动力学指标结果C组肾素活性血糖于切开腹膜后各时点较麻醉前升高P<0.05胰岛素于切开腹膜后各时点较麻醉前降低P<0.05皮质醇生长素于切除子宫时增高P<0.05结论四种麻醉方法均能抑制子宫切除引起的应激反应尤以腰硬联合阻滞全麻复合硬膜外阻滞为著异丙酚靶控输注插管全麻虽能抑制气管内插管引起的应激反应但不能完全抑制手术导致的肾素活性皮质醇血糖升高和胰岛素降低关键词硬膜外阻滞腰硬联合阻滞异丙酚靶控输注插管全麻全麻复合硬膜外阻滞子宫切除应激反应中图分类号!R614文献标识码!AThecomparationofthestressinhysterectomywithVario
3、usmethodofanaesthesiaCHENGXiang,LIUBao-jiang(DepartmentofAnesthesioIogy,SecondhospitaI,SanxiMedicaIUniversity,Taiyuan030001China)AbstractObjectiVeTostudythemethodofanaesthesiafortheproperstressofpatientswithhysterec-tomy.MethodsChooseaged30-60caseswhichweregoingtotakecuttingoffwomb,ASA!~"cIass,tot
4、aIIy60exampIe,thesecasesweredividedintofourgroupsrandomIy.ThegroupAchoosedtheepiduraIbIock.ThegroupBchoosedcombinedspinaIandepiduraIanaesthesia.ThegroupCchoosedendotracheaIintubationgenera1anaesthesiawithtargetcontroIIedinfusionofpropofoI.ThegroupDchoosedgeneraIanaesthesiacombinedepiduraIbIock.Eac
5、hgroupwastakenbIoodsampIebeforeanaesthesia,aftertheanaesthesia5min,cuttingopentheperitoneum,cuttingoffthewomb,theoperationfinishedtodeterminethefoIIowingsignsgrenin(PRA),angiotensin"(A")aIdosterone(ALD),corticosteroid(COR),insuIin(INS),bIoodsugar(GLU),growthhormone(GH),whiIemonitorringhemodynamics
6、.ResultsTheIeveIofrenninandbIoodsugarofgroupCgoesupincuttingopentheperitoneumandcuttingoffwomb,showsthesignificantdifferencecomparedwiththeIeveIbeforeanaesthesia.ThegroupCCORandGHishigherthantheIeveIbeforetheanaesthesiaintheexcisionwomb,afterpuIIoutingthetube5min,andtheIeve1ofgroupCissignificantIy
7、differentfromtheIeveIofothergroups,thegroupCtheinsuIingoesdownaftercuttingopentheperitoneummorethantheIeveIbeforeanaesthesia.ConclusionsThefourkindsofanaesthesiacanaIIrepressthestressofthepatientswithhysterec-tom
