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针药复合麻醉颅后窝手术病人血浆儿茶酚胺的变化杨庆国 陈锡明 杭燕南 许灿然 孙大金


  (上海第二医科大学附属仁济医院麻醉科,上海200127)

  [摘 要] 目的:观察针药复合麻醉对颅脑手术病人交感肾上腺髓质系统的影响。

  方法:30例颅后窝手术病人分为全麻组、针麻组和针药复合麻醉(GAE)组,测定围手术期外周静脉血去甲肾上腺素和肾上腺素的浓度。

  结果:针麻组儿茶酚胺水平从手术开始至术后3h均显著高于全麻组和GAE组,术后第1~4天3组间无明显差异。全麻组和GAE组术中儿茶酚胺水平无明显变化,但术后明显升高。

  结论:从应激角度进行评价,与全麻比较,针麻用于颅后窝手术术中儿茶酚胺反应显著,并无突出优点。而GAE可明显抑制颅后窝手术病人术中儿茶酚胺反应。

  [主题词] 针药复合麻醉;颅窝,后/外科手术;去甲肾上腺素/血液;肾上腺素/血液ChangesofPlasmaCatecholaminesinPatientsUndergoingPosteriorCranialFos

saSurgeriesUnderAcupunctureAnesthesiaCombinedwithAnestheticsYangQingguo,ChenXimi

ng,HangYannan,etal.(DepartmentofAnesthesia,RenjiHospital,ShanghaiSecondMedicalUniversity,

Shanghai200127)[Abstract] Purpose Toinvestigatetheeffectofelectroacupuncturecombinedwithanestheticsonthesymp

atheticadrenomedullarsysteminpatientsundergoingposteriorcranialfossasurg

eries.Methods Thirtypatientsweredividedintothegeneralanesthesia(GA)group,electroacupuncture(EA)group,andgeneralanesthesiapluselectroacup

uncture(GA+EA)group.Peripheralbloodsamplesweretakenatcertaintimepointsbeforeandafterthe

operation,andtheconcentrationsofplasmanoradrenalineandadrenalineweredetermined.

Results ThecatecholaminevaluesintheEAgroupweremarkedlyhigherthanthoseintheGAand

GA+EAgroupatthebeginningofand3hoursaftertheoperation.Therewerenosignificantd

ifferencesamongthethreegroupsinthefirst4daysaftertheoperation.Alsonosignifica

ntchangesincatecholaminelevelswerefoundbetweentheGAandGA+EAgroupsduringth

eoperation,buttheywereincreasedsignificantlyaftertheoperation.Conclusion:Inthelightofstress,nosu

periorityisexhibitedbyusingEAinposteriorcranialfossasurgeriescomparedwith

GA.However,GA+EAhasamarkedsuppressiveeffectoncatecholaminereactionsinthepatients

undergoingposteriorcranialfossasurgeries.

  [Keywords]AcupunctureMedicAnesthesia;CranialFossa,Posterior/surg;Norepinephrine/

blood;Epinephrine/blood

  手术病人的交感肾上腺髓质系统往往因手术刺激而出现明显反应,血浆儿茶酚胺显著升高,干扰生理平衡,严重影响病人的术后恢复。

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