Surgical stress hormones response is reduced after awake videothoracoscopy
Surgical stress hormones response is reduced after awake videothoracoscopy
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DOI：
10.1510/icvts.2009.224139
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发表时间：
2010-05-01
影响因子：
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通讯作者：
Mineo, Tommaso C.
中科院分区：
文献类型：
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作者：
Tacconi, Federico;Pompeo, Eugenio;Mineo, Tommaso C.
本研究旨在评估清醒状态下电视胸腔镜手术（VATS）后的应激激素反应。在基线、术后3小时（T1）、术后第2天（T2）和第3天（T3），对21例因非恶性疾病接受清醒VATS联合硬膜外麻醉（n = 11）或全麻下进行等同手术的患者的促肾上腺皮质激素（ACTH）、皮质醇、肾上腺素、去甲肾上腺素和葡萄糖的血浆水平进行了评估。两组中的肾上腺素水平在T1达到峰值，尽管仅对照组中发生了相对于基线值的显著变化[中位Delta：6 ng/l（IQR：4-6），P = 0.005]。在T1（15.5 μ g/dl vs. 23.0 μ g/dl，P = 0.001）和T2（15.2 μ g/dl vs. 19.2 μ g/dl，P = 0.002）时，研究组的皮质醇水平较低。在对照组中，皮质醇峰值水平被证明与ACTH的变化无关（R = 0.23，P = 0.46）。T2时，对照组的葡萄糖（137 mg/dl vs. 98 mg/dl，P = 0.01）和C反应蛋白（P = 0.04）较高。在非特异性急性反应因子中未发现其他临床相关的组间差异。总体而言，这些初步结果表明，与全麻和单肺通气下进行的等效手术相比，清醒VATS后的应激反应减弱。(C)2010年由欧洲胸外科协会出版。All rights reserved.
This study was undertaken to assess stress hormones response after awake videoassisted thoracoscopic surgery (VATS). Plasma levels of adrenal-corticotropic hormone (ACTH), cortisol, epinephrine, norepinephrine, and glucose were assessed at baseline, 3 h postoperatively (T1), and on postoperative mornings 2 (T2) and 3 (T3) in 21 patients undergoing awake VATS with epidural anesthesia for non-malignant conditions (n = 11) or equivalent procedures performed with general anesthesia. Epinephrine level peaked in both groups at T1, although significant change from baseline values occurred in the control group only [median-Delta: 6 ng/l (IQR: 4-6), P = 0.005]. Cortisol level was lower in the study group at T1 (15.5 mu g/dl vs. 23.0 mu g/dl, P = 0.001) and T2 (15.2 mu g/dl vs. 19.2 mu g/dl, P = 0.002). In the control group, peak cortisol level proved not to be related to changes in ACTH (R = 0.23, P = 0.46). At T2, glucose (137 mg/dl vs. 98 mg/dl, P = 0.01) and C-reactive protein (P = 0.04) were higher in the control group. No other clinically relevant between-groups differences were found in aspecific acute-response factors. Overall, these preliminary findings suggest attenuated stress response after awake VATS in comparison with equivalent procedure performed under general anesthesia and one-lung ventilation. (C) 2010 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.