Thoracic epidural anaesthesia and analgesia ameliorates surgery-induced stress response and postoperative pain in patients undergoing radical oesophagectomy
Thoracic epidural anaesthesia and analgesia ameliorates surgery-induced stress response and postoperative pain in patients undergoing radical oesophagectomy
复制标题
胸段硬膜外麻醉和镇痛可改善接受根治性食管切除术的患者手术引起的应激反应和术后疼痛
DOI：
10.1177/0300060519866943
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发表时间：
2019-08-19
影响因子：
1.6
通讯作者：
Zhong, Jing
中科院分区：
文献类型：
--
作者：
Wang, Jing;Yin, Yuehao;Zhong, Jing
目的 与大手术相关的急性严重应激反应会对炎症和激素反应产生不利影响。我们假设全静脉麻醉（TIVA）联合胸段硬膜外麻醉镇痛（TEA）可以减轻接受根治性食管切除术的患者的应激反应和术后疼痛。方法 将 40 名计划接受择期根治性食管切除术的患者随机分配到两组中的一组：TIVA 或 TIVA+TEA。评估血浆应激激素和细胞因子水平、芬太尼用量、术后48小时内视觉模拟评分（VAS）评分以及拔管时间。结果 TIVA组术后3 h血浆白细胞介素6、去甲肾上腺素、皮质醇、促肾上腺皮质激素水平显着高于TIVA+TEA组。手术开始后3小时，TIVA组血浆白细胞介素10水平显着低于TIVA+TEA组。 TIVA组芬太尼用量明显高于TIVA+TEA组，VAS评分明显较高，拔管时间明显较长。结论 研究结果表明，TIVA 和 TEA 联合使用可以减轻根治性食管切除术患者的术中应激反应和术后疼痛。
Objective An acute severe stress response associated with major surgery can adversely affect the inflammatory and hormonal responses. We hypothesised that total intravenous anaesthesia (TIVA) combined with thoracic epidural anaesthesia and analgesia (TEA) attenuates the stress response and postoperative pain in patients undergoing radical oesophagectomy. Methods Forty patients scheduled for elective radical oesophagectomy were randomly assigned to one of two groups: TIVA or TIVA+TEA. The plasma levels of stress hormones and cytokines, consumption of fentanyl, postoperative visual analogue scale (VAS) scores within 48 hours, and extubation time were assessed. Results The plasma levels of interleukin-6, norepinephrine, cortisol, and adrenocorticotropic hormone at 3 hours after the beginning of surgery were significantly higher in the TIVA group than TIVA+TEA group. The plasma level of interleukin-10 at 3 hours after the beginning of surgery was significantly lower in the TIVA group than TIVA+TEA group. The consumption of fentanyl was significantly greater, VAS scores were significantly higher, and extubation time was significantly longer in the TIVA group than TIVA+TEA group. Conclusions The findings suggest that combination of TIVA and TEA may attenuate the intraoperative stress response and postoperative pain in patients undergoing radical oesophagectomy.