硬膜外麻醉复合全身麻醉在老年退变性腰椎管狭窄症手术中的应用效果

Application Effect of Epidural Anesthesia Combined with General Anesthesia in Surgery for Degenerative Lumbar Spinal Stenosis in Elderly

目的:探讨硬膜外麻醉和全身麻醉在老年退变性腰椎管狭窄症手术中的应用效果。方法:选取2022年8月—2023年8月核工业四一七医院收治的92例老年退变性腰椎管狭窄症手术患者作为研究对象,按照随机数表法将患者分为对照组和研究组,各46例。对照组采用全身麻醉,研究组在对照组基础上复合硬膜外麻醉,对比两组麻醉效果及围手术期相关指标。结果:研究组术后2 h(T_(2))和术后6 h(T_(3))时视觉模拟评分法(VAS)评分和不良反应发生率低于对照组,麻醉起效时间短于对照组,持续镇痛时间长于对照组,术后24 h内镇痛药物用量少于对照组,差异有统计学意义(P<0.05)。研究组T_(3)时平均动脉压、心率和丙二醛(MDA)水平低于对照组,超氧化物歧化酶(SOD)水平高于对照组,术后12 h(T_(4))时Kolcaba舒适度评分和T_(2)时苏醒质量评分高于对照组,苏醒时间短于对照组,差异有统计学意义(P<0.05)。结论:硬膜外麻醉复合全身麻醉在老年退变性腰椎管狭窄症手术中的应用效果较好,能促使患者心率和平均动脉压等血流动力学指标稳定,减轻术后疼痛,提高苏醒质量,缓解氧化应激刺激,加快预后康复,并降低不良反应发生风险,实用性和安全性更高。

Objective:To explore the application effect of epidural anesthesia combined with general anesthesia in surgery for degenerative lumbar spinal stenosis in elderly.Method:A total of 92 elderly patients with degenerative lumbar spinal stenosis who admitted to the Nuclear Industry 417 Hospital from August 2022 to August 2023 were selected as the research objects,the patients were divided into the control group and the study group according to the random number table method,with 46 cases in each group.The control group was treated with general anesthesia,and the study group was combined with epidural anesthesia on the basis of the control group.The anesthetic effect and perioperative related indicators of two groups were compared.Result:The visual analogue scale(VAS)score at 2 h(T_(2))and 6 h(T_(3))after operation and incidence of adverse reactions in the study group were lower than those in the control group,the onset time of anesthesia was shorter than that in the control group,the duration of continuous analgesia was longer than that in the control group,and the dosage of analgesic drugs within 24 h after operation was less than that in the control group,the differences were statistically significant(P<0.05).The mean arterial pressure,heart rate and malondialdehyde(MDA)level at T_(3) in the study group were lower than those in the control group,the superoxide dismutase(SOD)level was higher than that in the control group,the Kolcaba comfort score at 12 h after operation(T_(4))and the recovery quality score at T_(2) were higher than those in the control group,and the recovery time was shorter than that in the control group,the differences were statistically significant(P<0.05).Conclusion:The application effect of epidural anesthesia combined with general anesthesia in surgery for degenerative lumbar spinal stenosis in elderly is good,which can promote the stability of hemodynamic indicators such as heart rate and mean arterial pressure,reduce postoperative pain,improve awakening quality,alleviate oxidative stress stimulation,accelerate prognosis and recovery,and reduce the risk of adverse reactions,it has higher practicality and safety.