Effects Of Different Anesthesia Techniques On The Perioperative Plasma Cortisol And D-dimer Levels In Caesarean Section

Background:Deep vein thrombosis (DVT) is a serious perinatal complication. All or part of thrombosis will flow lung along of blood when vein thrombosis fall. That will lead to acute pulmonary embolism and threat safety of lying-in woman which is one of the primary cause leading to maternal death. Stress response during caesarean section can activate coagulation system, enhance the post-operation coagulation and further increase the postnatal DVT risk. D-dimers is the degradation products of cross-linked fibrin. It is a sensitive marker of fibrinolysis and used early screening DVT. D-Dimer rising up shows the hypercoagulabale state and Hyperfibrinolysis.Any nociceptive stimulus could cause organism stress reaction. The patient's anxiety before surgery, intraoperative anesthesia and invasive surgery, postoperative pain can make an enhanced secretion of cortisol concentrations, the terminal hormone of the hypothalamus-pituitary- adrenal (HPA) axis, increased rapidly.So, cortisol is the one of index reflecting stress degree. Epidural anesthesia (EA) and Combined spinal-epidural anesthesia(CSEA) have been used widely in caesarean section. Both of them can better block the harmful stimulation during operation to the nerve center and can inhibit the secretion of cortisol. However, maternal psychological stress and vagal reflex in the surgery persist which impact of anesthesia on stress control. Hypotension is a common complication of vertebral canal nerve blockage in cesarean section. The main reason is due to relatively low blood volume because of sympathetic blocked and reduction of blood volume back to the heart.There are many factors that influence the secretion of cortisol in the perioperative of cesarean section. The views of the influence on the secretion of cortisol about the EA and CSEA are different. The effect on D-dimer levels in the perioperative of cesarean section has not been reported.Objective:The aim of the present study was to evaluate the perioperative plasma corticosteroid levels and the pattern of D-dimer alterations under epidural anesthesia or combining lumbar-epidural anesthesia.Methods:A total of 40 ASAⅠ-Ⅱ,36-41 weeks of gestation women undergoing elective cesarean section (CS) were randomly allocated to Group E (epidural anesthesia, n=20) or Group C (combining spinal-epidural anesthesia, n=20).Noninvasion blood pressure, electrocardiogram, oxygen saturation were measured. Blood samples were taken at pre-anaesthesia (test 0, TO), pre incide (test 1, T1), Fetal disengaged (test 2, T2), operative end (test 3, T3), postoperative 24 hr (test 4, T4) and 72 hr (tes5 1, T5). Plasma corticosteroid and D-dimers levels were analyzed by quantitative enzyme-linked immunosorbent assay (ELISA).Results:1. The Mean arterial pressure (MAP) in group C at T1 was significantly lower than that at TO (P<0.05). MAP of group E and C were (83.60±9.76), (75.65±11.72) mmHg at T2 respectively, which were declined notably than those at TO (P<0.05), and SBP was remarkably lower on group C than group E.The Heart rate (HR) in group E at T1 and T2 was significantly faster than that at TO (P<0.05). HR in group C at T2 and T3 was significantly faster than that at TO (P<0.05).2. The Concentration of cortisol at TO were (320.30±81.89) and (316.30±77.56) ug/L in group E and C, respectively (P>0.05). Concentration of cortisol in group C at T1 was 352.13±83.72 ug/L, which was significantly higher than that at TO (P<0.05). Concentration of cortisol in E and C groups were (357.15±72.57,(406.50±93.84) ug/L at T2 and (349.20±71.78),(392.40±64.83) ug/L at T3, respectively, which elevated significantly than those at TO in the patients of both groups (P<0.05). Concentration of cortisol was significantly higher in group C than that in group E (P<0.05).3. The D-dimer level at TO were (0.28±0.17) and (0.26±0.16) mg/L in group E and C, respectively (P>0.05). There were no changes at T0,T1 until T2 D-dimer levels were found to be above normal values before surgery. The D-dimer level at T3 were (0.41±0.21) and (0.36±0.18) mg/L in group E and C respectively, which were significantly higher than that at TO (P<0.05), but there were no difference between two groups. The levels of D-D increased after 24 h:0.46±0.29 mg/L (group E) and0.65±0.37 mg/L (group C), p=0.048. After 72h D-D began to decrease:0.19±0.11 mg/L (group E) and 0.31±0.17 mg/L (group C), p=0.036.Conclusions:Epidural anesthesia had a lower secretion of cortisol and effect of D-dimer concentration than combining spinal-epidural anesthesia in uterine-incision delivery.