全麻联合硬膜外麻醉对高血压老年患者腹腔镜胆囊切除术患者血流动力学、应激水平的影响

Effects of general anesthesia combined with epidural anesthesia on hemodynamics and stress levels in elderly patients with hypertension and laparoscopic cholecystectomy

目的:研究全麻联合硬膜外麻醉对高血压老年患者血流动力学、应激水平的影响。方法:选取2014年3月至2015年3月我院接诊的80例行腹腔镜胆囊切除术高血压老年患者作为本次研究对象。按照随机数表法分为观察组和对照组,观察组实施全麻联合硬膜外麻醉,对照组实施单纯全身麻醉,观察两组患者不同时间点血流动力学变化、不同时间点应激水平变化、麻醉苏醒时间比较、不良反应情况。结果:观察组与对照组相比,收缩压(systolic pressure,SBP)、舒张压(diastolic pressure,DBP)、心率(heart rate,HR)明显下降,与T1(手术前)时段比较,对照组各指标在T2(插管时)、T3(手术中)、T4(拔管后)时段有明显的上升,比较差异具有统计学意义(P<0.05);观察组各指标在T2、T3、T4时段略有上升,无统计学意义(P>0.05);观察组患者皮质醇、肾上腺素、内皮素在T2、T3、T4时段低于对照组,差异具有统计学意义(P<0.05);观察组自主呼吸恢复时间、拔管时间、完全清醒时间(4.70±1.02、7.80±2.26、16.29±5.28)min均小于对照组(9.78±3.01、15.83±3.29、28.30±5.22)min,比较差异具有统计学意义(P<0.05);观察组不良反应总发生率7.50%(3/40)小于对照组42.50%(17/40),比较差异具有统计学意义(P<0.05)。结论:全麻联合硬膜外麻醉能够减少高血压老年患者LC患者血流动力学、应激水平的影响,改善患者的预后,提高治疗疗效。

Objective： To study the effect of general anesthesia combined with epidural anesthesia on hemodynamics and stress level in elderly patients with hypertension.Methods： 80 cases of patients with admissions for laparoscopic gallbladder resection surgery in senile essential hypertension from 2014 March to March 2015 our hospital were researched. They were randomly divided into observation group and control group. Observation group were treated by implementation of general anesthesia combined with epidural anesthesia; control group received the implementation of a simple general anesthesia. Observed the changes of hemodynamic and stress level at different time points, the anesthesia recovery time and adverse reaction of the two groups.Results： Compared with the control group, SBP, DBP and HR in observation group decreased significantly; compared with the T1 （before operation） period, each index in T2 （intubation time）, T3 （operation）, T4 （atfer extubation） period in control group has obvious rise, the difference was statistically signiifcant （P〈0.05）; each index in T2, T3, T4 period in observation group slightly increased, with no statistical signiifcance （P〉0.05）; in the observation group, the levels of cortisol, epinephrine and endothelin in T2, T3 and T4 were lower than those in the control group, the difference was statistically signiifcant （P〈0.05）; the spontaneous breathing recovery time, extubation time and fully awake time in the observation group [（4.70±1.02, 7.80±2.26, 16.29±5.28） min] were less than those [（9.78±3.01, 15.83±3.29, 28.30±5.22） min] in the control group, the difference was statistically signiifcant （P〈0.05）; incidence rate of adverse reactions in the observation group [7.50% （3/40）] was less than that [42.50% （17/40）] in the control group, the difference was statistically significant （P〈0.05）.Conclusion： General anesthesia combined with epidural anesthesia can reduce the effect of laparoscopic cholecystectomy （LC） on hemodynamics and stress level in elderly patients with hypertension, and improve the prognosis and improve the therapeutic effect.