针药复合麻醉对心内直视手术患者下丘脑-垂体-肾上腺皮质轴反应和糖代谢的影响

Effect of Combined Drug-Acupuncture Anesthesia on Hypothalamo-Pituitary-Adrenocortical Axis Response and Glucose Metabolism in Open-Heart Surgery Patients

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DOI：

中文关键词: 电针心内直视手术 β内啡肽促肾上腺皮质激素皮质醇血糖

英文关键词:electroacupuncture open heart surgery β endorphin adrenocorticotropic hormone cortisol blood glucose

基金项目:“九五”国家重点科技项目基金资助 (No .96- 90 6- 1 1 - 0 1 )

作者	单位
杨庆国	上海第二医科大学附属仁济医院麻醉科
杭燕南	上海第二医科大学附属仁济医院麻醉科
孙大金	上海第二医科大学附属仁济医院麻醉科
陈锡明	上海第二医科大学附属仁济医院麻醉科
王祥瑞	上海第二医科大学附属仁济医院麻醉科
许灿然	上海第二医科大学附属仁济医院麻醉科
姚建玲	上海第二医科大学附属仁济医院麻醉科

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中文摘要:

目的 :观察电针对体外循环心内直视手术 (OHSC)患者下丘脑 -垂体 -肾上腺皮质 (HPA)轴反应和糖代谢的变化 ,并对针药复合麻醉用于OHSC予以评价。方法 :选择房间隔缺损修补术患者 30例 ,分为全麻组、针麻组和全麻复合电针 (GAE)组。分别于麻醉前、转流前和停转流后 30min采集外周静脉血 ,测定β 内啡肽 (β EP)、促肾上腺皮质激素 (ACTH)、皮质醇和血糖的浓度。结果 :全麻组和针麻组 β EP、ACTH和皮质醇在停转流后 30min显著升高 ,而GAE组无显著变化。停转流后 30min 3组血糖均明显升高 ,但GAE组明显低于全麻组和针麻组。结论 :全麻或针麻对OHSC的HPA轴和糖代谢反应无明显抑制作用 ,而GAE能明显抑制OHSC的 β EP、ACTH、皮质醇反应和血糖升高。从应激角度进行评价 ,GAE可作为OHSC的一种较好的复合麻醉方法。

英文摘要:

To study and evaluate the effect of electroacupuncture (EA) on hypothalamo pituitary adrenocortical (HPA) axis response and glucose metabolism in open heart surgery patients undergoing cardiopulmonary bypass (CPB). Methods: Thirty patients with atrial septal defect were divided into 3 groups, the general anesthesia group (A), the acupuncture anesthesia group (B) and the general anesthesia combined EA group (C). Peripheral blood samples were collected at the time before anesthesia, before CPB and 30 min after CPB to determine plasma β endorphin, adrenocorticotropic hormone (ACTH), serum cortisol and blood glucose. Results: Plasma β endorphin, ACTH and serum cortisol increased significantly in Group A and B 30 min after CPB but without significant change in Group C. Blood glucose increased in all the 3 groups 30 min after CPB but the increment in Group C was the lowest. Conclusion: Group A and B showed no significant inhibitory effect on HPA axis response and glucose metabolism in open heart surgery patients undergoing CPB, but Group C could obviously inhibit those responses. Assessment from the viewpoint of stress, the general anesthesia combined with EA is the better approach for anesthesia in open heart surgery with CPB.

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