不同麻醉方式对老年骨科手术患者术中应激反应及血流动力学的影响

Influence of different anesthesia methods on stress reaction and hemodynamics for elder orthopedics patients during operations1

目的:探讨全身麻醉、硬膜外麻醉、腰麻联合硬膜外(腰硬联合)麻醉对老年骨科手术患者术中应激反应及血流动力学的影响。方法:将90例择期行骨科手术的老年患者随机分为A、B、C 3组,各30例,分别采取全身麻醉、硬膜外麻醉、腰硬联合麻醉进行手术;对比分析3组患者麻醉前(T0)、切皮时(T1)、切皮后1h(T2)及术毕拔管时(T3)促肾上腺皮质激素(ACTH)、皮质醇(Cor)、β-内啡肽(β-EP)、血管紧张素-Ⅱ(Ang-Ⅱ)、心率(HR)、血压(SBP、DBP)的变化情况。结果:T1、T2时,3组患者的ACTH、Cor、β-EP、Ang-Ⅱ水平均明显高于T0(P<0.05),SBP、DBP明显低于T0(P<0.05),HR在T2时明显低于T0(P<0.05);T3时,3组各指标均恢复至与T0相近的水平(P>0.05);T1、T2时,B、C组的ACTH、Cor、β-EP、Ang-Ⅱ水平均明显低于A组(P<0.05),且C组比B组更低(P<0.05);B、C组的SBP、DBP均明显高于A组(P<0.05),HR在各组间差异无统计学意义(P>0.05)。结论:在临床麻醉中,应结合患者的实际情况来选择合适的麻醉方式,腰硬联合麻醉对老年骨科手术患者术中血流动力学的影响较小,并能有效减轻术中应激反应。

Objective：To investigate the influence of general anesthesia,epidural anesthesia and combined spinal and epidural anesthesia methods on stress reaction and hemodynamics for elder orthopedics patients during operations.Methods：A total of 90 cases of elder patients who would be arranged for orthopedic operations were randomly divided into group A,B and C,30 cases each group.Three groups of patients were separately arranged general anesthesia,epidural anesthesia and combined spinal and epidural anesthesia for operations;The variations of adrenocorticotrophic hormone（ACTH）,Cortisol（Cor）,β-endorphin（β-EP）,Angiotensin-Ⅱ（Ang-Ⅱ）,heart rate（HR）and blood pressure（SBP,DBP）on patients in three groups before anesthesia（T0）,during skin incision（T1）,after skin incision（T2）and extubation after operation（T3）were compared and analyzed.Results：During T1 and T2,ACTH,Cor,β-EP,Ang-Ⅱlevels in three groups of patients were significantly higher than those during T0（P〈0.05）;SBP,DBP were significantly lower than those during T0（P〈0.05）;HR during T2 was significantly lower than that during T0（P〈0.05）;during T3,every index in three groups were recovered to levels close to which during T0（P〉0.05）;during T1 and T2,ACTH,Cor,β-EP,Ang-Ⅱlevels in group B and C were significantly lower than those in group A（P〈0.05）,and levels in group C were significantly lower than those in group B（P〈0.05）;SBP and DBP in group B and C were significantly higher than group A（P〈0.05）.No HR statistical significance appeared among each group（P〉0.05）.Conclusion：During clinical anesthesia,we should choose suitable anesthesia method according to the actual situations of patients.Combined spinal and epidural anesthesia had a slight influence on hemodynamics of elder orthopedics patients during operation,and it could effectively alleviate stress reaction during operation.