麻醉与应激：麻醉方式与皮质醇分泌

本文由“小麻哥的日常"授权转载

摘要译文(供参考)

全凭静脉麻醉下腹腔镜手术中深度和中度神经肌肉阻滞的皮质醇分泌模式：

一项前瞻性、单盲、随机对照试验

背景：

神经内分泌应激反应引起的生理变化取决于手术和麻醉的类型。

虽然减少这种反应的最佳神经肌肉阻滞深度尚不清楚，但深度神经肌肉阻滞可以改善手术环境。

因此，我们假设患者在深度神经肌肉阻滞的手术中的应激反应会低于中度神经肌肉阻滞。

方法：

这项前瞻性、随机、单盲的研究纳入了72例在全麻下进行腹腔镜妇科手术的患者，并将其分为D组（深度阻滞：目标TOF为0和强直后计数≥ 1） 或M组（中度阻滞：目标TOF计数1-3）。

主要结局指标是皮质醇和促肾上腺皮质激素水平的变化模式；

次要结局指标是患者的预后，如血液动力学变量、血糖水平、PACU的术后疼痛和停留时间。

结果：

两组67例患者（M组34例，D组33例）的基线特征具有可比性。

两组围手术期皮质醇和促肾上腺皮质激素水平均升高，但组间无显著差异。

围手术期血糖水平升高，术后血糖水平下降，但组间无显著差异。

术后疼痛、PACU的芬太尼需求和停留时间也具有可比性。

结论：

与中度神经肌肉阻滞相比，深度神经肌肉阻滞改善了手术环境，但在激素应激反应方面没有明显的组间差异。

图1.研究流程图

ASA=美国麻醉师协会，BMI=体重指数。

图2.中度和深度神经肌肉阻滞组之间应激激素和葡萄糖水平的比较

（A） 血清皮质醇水平的变化。

（B） 血清促肾上腺皮质激素水平的变化。

（C） 血糖水平的变化。

ACTH=促肾上腺皮质激素，D组=深度神经肌肉阻滞，M组=中度神经肌阻滞，T0=手术前，T1=手术结束，T2=手术后90分钟，†P < .01与组内T0相比，‡P < .01组内与T1相比为，§P > .05两组之间为。

原文摘要

Cortisol secretory patterns in deep and moderate neuromuscular blockades in laparoscopic surgery under total intravenous anesthesia:

A prospective, single-blinded, randomized controlled trial

Background: 

Neuroendocrine stress response induces physiological changes depending on the type of surgery and anesthesia. Although the optimal depth of neuromuscular blockade for reducing this response remains unknown, deep neuromuscular blockade is known to improve the surgical environment. Therefore, we hypothesized that a patient's stress response would be lower in surgical procedures under deep neuromuscular blockade than under moderate neuromuscular blockade.

Methods: 

This prospective, randomized, single-blind study enrolled 72 patients who underwent laparoscopic gynecological surgery under general anesthesia and were assigned to group D (deep blockade: target train-of-four 0 and posttetanic count ≥ 1) or group M (moderate blockade: target train-of-four count 1-3). The primary endpoints were changing patterns in cortisol and adrenocorticotrophic hormone levels; the secondary endpoints were patient outcomes, such as hemodynamic variables, serum glucose level, postoperative pain in the postanesthesia care unit, and hospital stay.

Results:

The baseline characteristics were comparable between the 67 patients included in the 2 groups (34 in group M and 33 in group D). Cortisol and adrenocorticotrophic hormone levels increased perioperatively in both groups but without significant intergroup differences. Serum glucose level increased perioperatively and decreased postoperatively, but without a significant intergroup difference. Postoperative pain, fentanyl requirement in the postanesthesia care unit, and hospital stay were also comparable.

Conclusions:

Compared with moderate neuromuscular blockade, deep neuromuscular blockade improved the surgical environment without significant intergroup differences in the hormonal stress response.

Figure 1. Flow diagram showing patient flow according to the study protocol. ASA = American Society of Anesthesiologists, BMI = body mass index.

Figure 2. Comparison of stress hormone and glucose levels between the moderate and deep neuromuscular blockade groups. (A) Changes in serum cortisol levels. (B) Changes in serum ACTH levels. (C) Changes in serum glucose levels. ACTH = adrenocorticotropic hormone, Group D = deep neuromuscular blockade, Group M = moderate neuromuscular blockade, T0 = before surgery, T1 = end of surgery, T2 = 90 min after the surgery. †P < .01 compared with T0 within group. ‡P < .01 compared with T1 within group. §P > .05 between 2 groups.

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编辑：Michel.米萱

校对：Mijohn.米江