喉罩联合麻醉对老年全髋置换术应激反应影响

Effects of General Anesthesia with Laryngeal Mask Airway Combined with Epidural Anesthesia on Stress Reaction of Elderly Patients Undergoing Total Hip Replacement

目的评价喉罩全麻联合硬膜外麻醉对老年全髋置换术者应激反应的影响。方法择期65～85岁老年全髋置换术患者80例随机均分为4组:A组(气管插管),B组(硬膜外麻醉联合气管插管),C组(喉罩),D组(硬膜外麻醉联合喉罩)。记录4组患者基础值(T0)、气管插管/置入喉罩后即刻(T1)、骨膜剥离(T2)、拔管前即刻(T3)和拔管后3min(T4)的平均动脉压(MAP)和心率(HR);并于上述时间点采静脉血检测肾上腺素(E)、去甲肾上腺素(NE)水平。结果 T1、T3、T4时A、B组MAP、HR及血浆E、NE水平明显高于T0时(P<0.05);T2时A、C组MAP、HR及血浆E、NE水平明显高于B、D组(P<0.05);D组T1～T4时MAP、HR及血浆E、NE水平无明显变化。结论硬膜外麻醉联合喉罩全麻用于老年患者全髋置换术,患者血流动力学稳定,有效减轻应激反应。

Objective To evaluate the efficacy of general anesthesia（GA） with laryngeal mask airway（LMA） combined with epidural anesthesia on the stress reaction of elderly patients undergoing total hip replacement. Methods A total of 80 elderly patients（65 -85 years） scheduled for selective total hip replacement were randomly divided into four groups：A（ GA with tracheal intubation）, B （GA with tracheal intubation and epidural anesthesia）, C （GA with LMA） and D （GA with LMA and epidural anesthesia）. The changes of MAP and HR were recorded at baseline（ T0 ）, immediately after LMA insertion or intubation（ T1 ）, detaching periosteum（T2 ）, immediately before LMA withdrawal or extubation（T3 ） and 3 min after LMA withdrawal or extubation （T4 ）. Blood specimens were taken at To - T4 for determine of plasma concentration of epinephrine （E） and norepinephrine （NE）. Results MAP, HR, NE and E in groups A and B were significantly higher at T1 , T3 and T4 than those at TO （P 〈 0.05）, in groups A and C were significantly higher at T2 than the other groups（P 〈0.05）. There was no significant difference in MAP, HR, NE and E in group D at TI-T4. Conclusion GA with LMA combined with epidural anesthesia in the elderly patients undergoing total hip replacement can maintain a stable hemodynamics and effectively reduce the stress reaction.