两种麻醉方式用于老年高血压患者腹腔镜全子宫切除术的对比研究

A comparison of two kinds of anesthesia methods for laparoscopic total hysterectomy in elderly patients with hypertension

目的观察单纯全身麻醉与硬膜外麻醉复合全身麻醉对老年高血压患者腹腔镜全子宫切除术应激反应的影响。方法选择择期行腹腔镜全子宫切除术的老年高血压手术患者100例按随机数字法分为两组,每组50例。Ⅰ组采用全身麻醉方式,Ⅱ组采用硬膜外复合全身麻醉方式。分别于入室后(T_1)、插管即刻(T_2)、建立气腹即刻(T_3)、拔管即刻(T_4)、术后2 h(T_5)采集患者外周静脉血,测定促肾上腺素皮质激素(ACTH)、内皮素(ET)、皮质醇(COR)、去甲肾上腺素(NE)水平,并记录各时间点平均动脉压(MAP)和心率(HR)的变化值。结果 (1)血流动力学变化:T_1时两组患者MAP、HR差异无统计学意义(P>0.05)。与T_1相比,Ⅰ组患者MAP、HR在T_2~T_4时显著升高(P<0.05或P<0.01);Ⅱ组患者仅在T_3、T_4时HR明显升高(P<0.05)。与Ⅱ组相比,Ⅰ组患者MAP、HR在T_2~T_4时点显著增高(P<0.05或P<0.01)。(2)应激激素变化:T_1时两组患者血清ACTH、ET、COR、NE水平差异无统计学意义(P>0.05)。与T_1相比,Ⅰ组各激素水平在T_2~T_4时均显著升高(P<0.05或P<0.01);Ⅱ组仅在T_4时升高(P<0.05)。与Ⅱ组相比,Ⅰ组各激素水平在T_2~T_4时刻均明显增高,差异有统计学意义(P<0.05或P<0.01)。结论硬膜外复合全身麻醉可有效降低老年高血压患者腹腔镜手术应激反应,维持术中血流动力学稳定。

Objective To compare the stress response of general anesthesia with epidural anesthesia combined with general anesthesia in elderly patients with hypertension undergoing total laparoscopic hysterectomy(TLH).Methods One hundred cases of elderly patients with hypertension undergoing elective TLH were randomly assigned into two groups,50 cases in each group.Group I was treated with general anesthesia while group Ⅱwas treated with epidural anesthesia combined with general anesthesia.Level of adrenocorticotropic hormone(ACTH),endothelin(ET),cortisol(COR) and norepinephrine(NE) in peripheral blood of patients were measured at five times nodes including after entering the operating room(T_1),intubation(T_2),the establishment of pneumoperitoneum(T_3),extubation(T_4),two hours after operation(T_5),and hemodynamics parameters including mean arterial pressure(MAP) and heart rate(HR) at each time point were also recorded.Results(1) As for hemodynamic changes,MAP and HR had no significant differences at T_1 between the two groups(P > 0.05).Compared with T_1,MAP and HR of the group Ⅰ were significantly higher at T_2 to T_4(P <0.05 or P < 0.01); but HR of the group Ⅱwas only significantly increased at T_3 and T_4(P < 0.05).Compared with group Ⅱ,HR and MAP of group I were significantly increased at T_2 to T_4(P < 0.05 or P < 0.01).(2) As for stress hormone changes: the levels of serum ACTH,ET,COR and NE had no significant differences between the two groups at T_1(P > 0.05).Compared with T_1,four hormone levels in group I were significantly increased at T_2 to T_4(P <0.05 or P <0.01); in group II,the hormone levels were elevated only at T_4(P < 0.05).Compared with group Ⅱ,the hormone levels of the group I were significantly increased in T_2 to T_4,and the differences were statistically significant(P < 0.05 or P < 0.01).Conclusions Epidural anesthesia combined with general anesthesia can effectively reduce the stress response in elderly patients with hypertension,and maintain the stability of hemodynamics during operation.Therefore,it is an ideal anesthesia method which is worthy of clinical application.