腰-硬联合麻醉对老年骨科手术患者应激反应及血流动力学的影响

Influence of combined spinal-epidural anesthesia on stress response and hemodynamics in senile patients with orthopedic surgery

目的探讨腰-硬联合麻醉对老年骨科手术患者应激反应及血流动力学的影响。方法选择2015年2月~2016年2月于我院进行手术治疗的100例老年骨折患者作为研究对象,按照随机数字表法分为观察组与对照组,各50例。对照组予以全身麻醉,观察组采用腰-硬联合麻醉,比较两组的应激反应及血流动力学指标变化。结果观察组的肾上腺素、血管紧张素、肾素、去甲肾上腺素水平均低于对照组,差异有统计学意义(P<0.05)。两组麻醉前的DBP、SBP、HR指标水平比较,差异无统计学意义(P>0.05)。两组麻醉后10、30 min的DBP、SBP、HR水平较麻醉前均呈现出明显下降趋势,且对照组下降速度更快,差异有统计学意义(P<0.05)。结论老年骨科手术患者采用腰-硬联合麻醉干预有利于减轻患者的应激反应,改善血流动力学指标,值得临床广泛应用。

Objective To investigate the influence of combined spinal-epidural anesthesia （CSEA） on stress response and hemodynamics in senile patients with orthopedic surgery.Methods 100 senile patients with fracture received surgery in our hospital from February 2015 to February 2016 were selected as the research object,and they were divid- ed into the observation group and the control group according to random number table method,50 cases in each group. The patients in control group was given general anesthesia,while the patients in observation group was given CSEA.The stress response and changes of hemodynamic indexes were compared between the two groups.Results The epinephrine, angiotensin,renin,norepinephrine in the observation group was lower than that in the control group,with statistical difference （P〈0.05）.Before the anesthesia,the level of DBP,SBP,HR between the two groups were compared,there was no sta- tistical difference （P〉0.05）.After the anesthesia for 10 rain and 30 min,the levels of DBP,SBP,HR in the two groups sig- nificantly decreased compared with those before anesthesia,and the descend speed of the control group was more quicker,with statistical difference （P〈0.05）.Conclusion CSEA in senile patients with orthopedic surgery is effective,it can reduce stress response and improve indexes of hemodynamies,which is worthy of clinical application.