The Comparation Of The Stress In Hysterectomy With Various Method Of Anaesthesia

objective: Study the method of anaesthesia for the proper stress of patients with hysterectomy . Methods: Choose aged 30 ～ 60 cases which were going to take cutting off womb, ASA Ⅰ～Ⅱ class, no endocrine disease, and no hormone used, totally 60 example, these cases were divided into four groups randomly.The group A choosed the epidural block.The group B choosed combined spinal and epidural anaesthesia.The group C choosed endotracheal intubation general anaesthesia with target controlled infusion of propofol.The group D choosed endotracheal intubation general anaesthesia with target controlled infusion of propofol combined epidural block .Each group was taken blood sample before anaesthesia , after the anaesthesia 5 min, cutting open the peritoneum, cuting off the womb, the operation finished to determine the following signs: renin(PRA), angiotensinⅡ ( A Ⅱ),aldosterone(ALD),corticosteroid(COR),insulin(INS),blood sugar(GLU), growth hormone(GH), while monitoring hemodynamics. Results: Each signs of various group before anaesthesia are comparable, no obvious difference.The level of renin of group A, B, D descends at other time point after anaesthesia,there is a significant difference compared with the level before anaesthesia,the level of group C goes up in cuting open the peritoneum and cuting off womb,shows the significant difference compared with the level before anaesthesia. Four groups had no significance in the changes of A Ⅱand ALD around the anaesthesia. The A,B,D groups COR,GH,INS have no significant change.The group C COR and GH is higher than the level before the anaesthesia in the excision womb, after pull outing the tube 5 min , and the level of group C is significantly diffrent from the level of other groups, the group C the insulin goes down after cutting open the peritoneum more than the level before anaesthesia.The group A the blood sugar descends after the anaesthesia, have a significant difference compared with the level before anaesthesia, and while cutting open the peritoneum it recovered to the level before anaesthesia,then cutting off the womb and the operation finished the blood sugar goes up again, have statistical significance contrasted with the level before anaesthesia. in the group B the blood sugar descends after the anaesthesia, going through the operation . In group C the blood sugar descends after the anaesthesia, have a siginificant difference compared with the level before anaesthesia, but after cutting open the peritoneum that increase highly at each time point, and significantly higher than the other groups. The group D the blood sugar descends after the anaesthesia, have statistical significance compared with the level before anaesthesia, and when cutting open the peritoneum and cutting off the womb it recovers to the level before anaesthesia, after pulling out the tube 5 min blood sugar significantly goes up before anaesthesia. the blood pressure and heart rate in the groupA,B all drop sharply after anaesthesia , the group C the systolic blood pressure goes down after the anaesthesia, and recoveres during the operation,but when after pulling out the tube 5 min it rises significantly again,the group C the diastolic blood pressure and the heart rate have no siginificant difference,the group D the blood pressure and the heart rate are lower than the level before the anaesthesia , after pulling out the tube 5 mins recoveres to the level before anaesthesia. Conclusions: The four kinds of anaesthesia can all repress the stress of the patients with hysterectomy, particularly combined spinal and epidural anaesthesia and endotracheal intubation general anaesthesia with target controlled infusion of propofol combined epidural block, so can the epidural block.Though endotracheal intubation general anaesthesia with target controlled infusion of propofol can repress the stress from endotracheal intubation, can't completely repress stress from surgical operation which lead to the dropping of INS and the rising of PRA,COR,GH,GLU.