关键词: 普外科手术, 肠粘膜屏障, 麻醉, 全身, 硬膜外, 麻醉

Abstract:

Objective〓〖WTBZ〗 To investigate the effect of thoracic epidural anesthesia combined with general anesthesia on the intestine barrier function. 〖WTHZ〗Methods〓〖WTBZ〗Twenty ASA class I-II patients undergoing elective upper abdominal surgeries were randomly divided into the general anesthesia group (group GA, n=10) and the general anesthesia combined with thoracic epidural anesthesia (TEA)group (group GE, n=10). Both groups received phenobarbital sodium 0.1g and atropine 0.5mg im 30 min prior to the surgery. In the GE group an epidural catheter was inserted through a needle placed at T 8-9 or T9-10 and cephalad for 3.5cm, and then 10ml 0.5% bupivacarine was injected into the epidural spare after giving a tail dose of 3 ml 2% lidocarine. In both groups anesthesia was induced with 0.05mg/kg midazolam, 3μg/kg fentanyl, 0.1mg/kg vecuronium and 0.15-0.25mg/kg etomidate and maintained with inhalation of 1%-2.5% isoflurance and inter-mitten iv boluses of fentanyl and vecuronium. After the operations, tramadol intravenous pump was given to the GA group and bupivacarine epidural pump was given to the GE group. The plasma D-lactate and Lip polysaccharide (LPS) levels and the intestine microbial DNA were determined the day before the operation (T1) and 0 (T2), 24 (T2) and 48 h(T4) after the operation by PCR.〖WTHZ〗 Results〓〖WTBZ〗Plasma D-lactate and LPS were significantly increased at T2, T3, and T4 compared with T1 and were higher in group GA than in group GE (P<0.05). Bacterial DNA was found in 4 patients in group GA and 2 patients in group GE (χ2=42.27, P<0.01). Also SIRS was found in 6 patients in group GA and 4 patients in group GE during 24h after surgeries (χ2=37.64, P<0.01).〖WTHZ〗 Conclusion〓〖WTBZ〗TEA combined with general anesthesia can reduce the intestine barrier dysfunction after upper abdominal surgery.

Key words: Anesthesia, epidural, Anesthesia, general, Abdominal surgery, Intestine barrier function