两种麻醉方式对老年高血压手术患者的麻醉影响及效果分析

Effects of two types of anesthesia on patients with senile hypertension

目的：观察硬膜外麻醉复合全身麻醉及全身麻醉对老年高血压患者麻醉效果的影响。方法选取驻马店市中心医院84例老年高血压行上腹手术患者为研究对象，抽签随机分为观察组与对照组，每组42例，观察组行硬膜外麻醉复合全身麻醉，对照组行全身麻醉，比较两组麻醉前（T0）、气管导管拔出时（T1）、术后6 h（T2）、术后24 h（T3）、术后48 h（T4）心率（HR）、血压及心肌酶指标变化情况。结果 T3、T4时对照组收缩压（SBP）较T0显著下降，舒张压（ DBP）在T1～T4时均发生较大改变，与对照组比较SBP、DBP在T1～T4时均显著降低，且与观察组T0比较差异有统计学意义，对照组HR未见显著改变，观察组HR在T3、T4时与T0时比较显著下降，差异有统计学意义（P〈0.05）；观察组T1时肌钙蛋白-Ⅰ（cTn-Ⅰ）水平显著下降，其他时间保持稳定，对照组T1～T4时cTn-Ⅰ水平均发生显著改变，与T0时比较差异有统计学意义（P〈0.05）。结论硬膜外麻醉复合全身麻醉在老年高血压患者手术中的应用效果优于全身麻醉，可抑制心肌损伤，具有较高的临床应用价值。

Objective To compare the effects of epidural compound anesthesia and general anesthesia on patients with senile hypertension. Methods Eighty-four patients with senile hypertension were randomly divided into two groups, with 42 cases in each group. Patients in control group were implemented of general anesthesia, and patients in observation group were implemented of epidural compound anesthesia combined with general anesthesia. The changes of heart rate, blood pressure and myocardial enzyme indexes were compared in different time：before anesthesia （T0）, when the endotra-cheal tube pulled out （T1） and 6 h（T2）, 24 h（T3） and 48 h（T4）after surgery. Results SBP of control group were sig-nificantly reduced in T3, T4 compared with T0, and DBP of control group were significantly changed in T1-T4. SBP and DBP of control group were significantly reduced in T1-T4 compared with that of the observation group in T0（P〈0. 05）. HR of observation group was significantly reduced in T3, T4 compared with T0 （P〈0. 05）, while the HR of control group was not significantly changed. The cTn-Ⅰof observation group significantly reduced in T1, while the cTn-Ⅰof control group signifi-cantly changed in T1-T4 compared with T0（P〈0. 05）. Conclusions The clinical application effect of epidural compound anesthesia is better than that of general anesthesia on patients with senile hypertension, which can inhibit myocardial injury.