Changes of fibrinolysis and stress responses in patients under different anesthesia techniques undergoing hysterectomy during perioperative period
- VernacularTitle:不同麻醉下子宫切除术病人围术期应激反应与纤溶功能的变化
- Author:
Yanqin QI
;
Tianlong WANG
;
Baxian YANG
- Publication Type:Journal Article
- Keywords:
Anesthesia, epidural;
Anesthesia,general;
Stress;
Fibrinolysis;
Hysterectomy
- From:
Chinese Journal of Anesthesiology
1994;0(05):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the changes of stress responses and fibrinolysis under three anesthesia techniques undergoing elective hysterectomy during perioperative period. Methods Thirty ASA Ⅰ or Ⅱ patients aged 31-57yr weighing 45-70 kg undergoing elective hysterectomy were divided randomly into 3 groups ( n = 10 each): group Ⅰ continuous epidural anesthesia (E); group Ⅱ general anesthesia combined with continuous epidural anesthesia (G + E) and group Ⅲ general anesthesia (G) . The patients in the 3 groups were all premedicated with midazolam 0.05 mg?kg-1 i.v. . In group G and G + E the patients received an additional scopolamine 0.3 mg i.v. . In group E and G + E an epidural catheter was placed through L1-2 interspace and 2% lidocaine 5 ml was given as test dose. The spinal segments blocked was extended from L3 to T6 using 0.75 % bupivacaine. In group G and G + E general anesthesia was induced with fentanyl 2-3 ?g ? kg-1, propofol 1.5-2.0 mg?kg-1 and vecuronium 0.1 mg?kg-1 and maintained with isoflurane inhalation and intermittent i.v. boluses of vecuronium. The patients were mechanically ventilated after tracheal intubation. BIS, ECG, BP, HR, SpO2 , PETCO2 and end-tidal isoflurane concentration were continuously monitored during operation. BIS value was maintained below 60. PCEA or PCIA was started as soon as the patients were awake. VAS scores were maintained below 3-4. Venous blood samples were taken before anesthesia (T0 baseline) at the end of operation (T1) and 24 and 72 h after operation (T2 , T3) for determination of plasma adrenaline (A) and noradrenaline (NA), D-dimer level (DD), tissue type plasminogen activator (t-PA ) and plasminogen activator inhibitor ( PAI-1) concentrations. Results The plasma NA and A concentrations in group G were significantly increased at T1-3 as compared to the baseline value at T0 and were significantly higher than those in group E and G + E. There was no significant difference in plasma NA concentration between group E and G + E. The DD level was significantly increased at T2 as compared to the baseline value at T0 in all 3 groups and remained high at T3 in group E and G + E. The t-PA and PAI-1 activities were significantly increased at T1 as compared to the baseline values at T0 in all three groups and then gradually decreasing at T2 and T3 . In group E the PAI-1 activity returned to baseline level at T3 . Conclusion Epidural anesthesia helps in maintaining fibrinolytic activity by attenuating the responses to surgical stress and inhibiting the increase in PAI-1 activity.
