两种麻醉方式对老年腹腔镜下胆囊切除术患者围术期应激反应的影响探究

Effect exploration of perioperative stress response of two different anesthesia methods for laparoscopic cholecystectomy in elderly patients

目的 探讨全麻（GA）和硬膜外麻醉复合全麻（GEA）两种麻醉方式对老年腹腔镜下胆囊切除术（LC）患者围术期应激反应的影响.方法 选择在解放军第一八一医院2011年8月～2013年5月择期行LC手术的老年患者56例,将所有患者随机分为实验组和对照组,每组各28例.对照组患者采用GA麻醉后行气管内插管,实验组患者采用GEA麻醉;在麻醉前、插管后、气腹后、术中30 min和拔管后的5个时间节点测定患者外周血中的血糖（Glu）、皮质醇（Cor）、C反应蛋白（CRP）水平,并记录各时间段血流动力学指标,包括心率（HR）、收缩压（SBP）、舒张压（DBP）和平均动脉压（MAP）.结果 实验组患者术中30 min和拔管后的Glu、Cor和CRP水平显著低于对照组,差异有统计学意义（P＜0.05）;两组患者HR、SBP、DBP和MAP相比较差异无统计学意义（P＞ 0.05）.结论 GEA与GA相比,对老年患者LC围术期的应激反应更小,值得在临床上进一步推广.

Objective To explore the effect of perioperative stress response of general anesthesia （GA） and epidural anesthesia combining general anesthesia （GEA） for laparoscopic cholecystectomy （LC） in elderly patients.Methods 56 cases of elderly patients undergoing elective LC surgery in 181st Hospital of Chinese People＇s Liberation Army from August 2011 to May 2013 were chosen and randomly divided into experimental group and control group,28 cases in each group.The control group was treated with GA underwent endotracheal intubation anesthesia,the experimental group was treated with GEA anesthesia.Level of glucose （Glu）,cortisol （Cor）,C-reactive protein （CRP） in peripheral blood of patients were measured at five time nodes including before anesthesia,intubation,pneumoperitoneum,30 min intraoperative and after extubation,and hemodynamics parameters including HR,SBP,DBP,and MAP at each time period were recorded.Results The level of Glu,Cor and CRP in experimental group at 30 min undergoing and after extubation were significantly lower than the control group,the differences were statistically significant （P ＜ 0.05）.The HR,SBP,DBP and MAP in patients of two groups had no significant differences （P ＞ 0.05）.Conclusion The perioperative stress response of GEA is smaller compare to GA in LC for elderly patients,thus worthy of further promotion in clinical practice.