全身麻醉联合硬膜外麻醉在老年高血压患者腹腔镜胆囊切除术中的应用

General anesthesia combined with epidural anesthesia in elderly patients with hypertension during laparoscopic cholecystectomy

目的探讨全身麻醉联合硬膜外麻醉在老年高血压患者腹腔镜胆囊切除术(LC)中的麻醉效果。方法将择期行LC的老年高血压患者64例分为对照组32例和观察组32例,分别采用全身麻醉和全身麻醉联合硬膜外麻醉,比较两组患者术中血流动力学情况[收缩压(SBP)、舒张压(DBP)、心率(HR)]、激素[生长激素(GH)、催乳素(PRL)和皮质醇(Cor)]水平及术后麻醉恢复情况。结果在T1、T2和T3时,观察组SBP和DBP均显著低于对照组(P<0.05),HR显著快于对照组(P<0.05);观察组GH分别为(11.44±2.27)mg/L、(8.03±2.56)mg/L和(9.34±2.82)mg/L,显著低于对照组的[(13.25±3.56)mg/L、(9.51±3.14)mg/L和(10.92±3.25)mg/L,P<0.05或P<0.01];PRL分别为(70.76±5.55)mg/L、(60.43±7.85)mg/L和(64.36±7.59)mg/L,显著低于对照组的[(81.32±4.03)mg/L、(73.01±8.04)mg/L和(76.39±6.65)mg/L,P<0.05或P<0.01];Cor分别为(480.33±26.16)mg/L、(469.27±28.76)mg/L和(477.91±21.78)mg/L,显著低于对照组的[(511.45±27.69)mg/L、(484.21±23.13)mg/L和(495.40±26.67)mg/L,P<0.05或P<0.01];观察组患者术后呼吸恢复时间、睁眼时间、拔管时间、定向力恢复时间分别为(7.81±3.12)min、(8.25±3.23)min、(16.73±4.28)min和(19.55±5.23)min,均显著短于对照组的[(10.20±3.87)min、(10.21±3.84)min、(21.45±4.50)min和(23.29±5.41)min,P<0.05或P<0.01];对照组苏醒期8例(25.0%)发生烦躁,明显高于观察组2例(6.3%,P<0.05)。结论全身麻醉联合硬膜外麻醉用于老年高血压患者行LC时血流动力学指标更稳定,激素应激反应更轻,麻醉恢复快。

Objective To explore the efficacy of general anesthesia combined with epidural anesthesia in elderly patients with hypertension during laparoscopic cholecystectomy （LC）. Method 64 elderly hypertensive patients with gallstone undergoing LC were divided into control group （n=32） and observation group （n=32）. The general anesthesia was applied to patients in control group,while general anesthesia combined with epidural anes- thesia in observation group. The hemodynamic changes in the two groups were recorded during operation including systolic blood pressure （SBP）,diastolic blood pressure （DBP）,and heart rates （HR）,and serum hormones,such as growth hormone （GH）,prolactin （PRL） and cortisol （Cor） were detected. Results The SBP in the observation group at T1 （immediately after intubation）,T2 （ten minutes after pneumoperitoneum） and T3 （immediately before extubation） were（159.49±6.26） mmHg,（153.48±6.42） mmHg and（158.41±6.33） mmHg,while in the control group were （163.34±5.52） mmHg, （157.22±5.75） mmHg and （161.30±5.16） mmHg, respectively （P〈0.05）;The DBP in the observation group were significantly lower than in the control group（P〈0.05）;The HR in the observation group were quicker than in the control group （P〈0.05）;Serum GH levels in the observation group at T1,T2 and T3 were （11.44±2.27） mg/L,（8.03±2.56） mg/L and（9.34±2.82） mg/L,obviously lower than in the control group [（13.25± 3.56） mg/L,（9.51±3.14） mg/L and （10.92±3.25） mg/L,respeetively,P〈0.05 or P〈0.01）;Serum PRL levels in the observation group were（70.76±5.55） mg/L,（60.43±7.85） mg/L and（64.36±7.59） mg/L,considerably lower than in the control group [（81.32±4.03） rag/L,（73.01±8.04） mg/L and （76.39±6.65） mg/L,respectively,P〈0.05 or P〈0.O1;The serum Cot levels in the observation group were（480.33±：26.16） rag/L,（469.27±28.76） mg/L and（477.91±21.78） mg/ L,markedly lower than in the control group [（511.45±27.69） mg/L,（484.21±23.13） mg/L and （495.40±26.67） mg/L, respectively,P〈0.05 or P〈0.01 ]; The postoperative breathing recovery time, eye opening time, extubation time, orienta- tion recovery time in the observer group were （7.81 ±3.12） min, （8.25±3.23） rain, （ 16.73±4.28 ） min and （ 19.55±5.23 ） min,markedly shorter than in the control group [（10.20±3.87） rain,（10.21±3.84） min,（21.45＋4.50） rain and（23. 29±5.41） min,P〈0.05 or P〈0.01];Eight cases （25.0%） in control group occurred wake irritability,while in obser- vation group were only two （6.3%,P〈0.05）. Conclusion It might be a stable hemodynamics,less hormonal stress and quick recovery from anesthesia in elderly patients with hypertension during LC when general anesthesia combined with epidural anesthesia are given.