硬膜外复合全身麻醉对开胸手术患者血流动力学和应激反应的影响研究

Effect of Hemodynamics and Stress Response of Epidural Combined with General Anesthesia in Thoracic Surgery

目的:研究硬膜外复合全身麻醉对开胸手术患者血流动力学和应激反应的影响。方法:选取120例我院2015年1月到2016年1月收治的开胸手术患者,按照随机数字表法将患者分为研究组和对照组,对照组给予单纯全麻,研究组给予硬膜外复合全身麻醉,比较两组苏醒时间、苏醒期收缩压、舒张压、心率及烦躁情况,并比较两组术前、术后72 h血糖、皮质醇以及肾上腺素水平。结果:两组苏醒时间比较无统计学意义(P>0.05),苏醒期研究组收缩压、舒张压及心率、烦躁发生率均较对照组降低(P<0.05);两组术前血糖、皮质醇及肾上腺素比较无统计学差异(P>0.05);术后72 h,两组血糖、皮质醇及肾上腺素均升高(P<0.05);研究组血糖、皮质醇及肾上腺素均较对照组降低(P<0.05)。结论:硬膜外复合全身麻醉应用于开胸手术能显著提高患者苏醒期苏醒质量,稳定血流动力学,改善其应激反应。

Objective： To study effect of hemodynamics and stress response of epiduralcombined with general anesthesia in thoracic surgery. Methods： 120 patients with thoracic surgery in our hospital from January 2015 to January 2016 were selected, and they were divided into study group and control group according to random number table. The control group was given general anesthesia, the study group was given epidural combined with general anesthesia. The recovery time, the systolic blood pressure, diastolic blood pressure, heart rate and irritability were compared between the two groups, the levels blood glucose, cortisol and epinephrine in two groups before and 72 h after operation were compared. Results： There was no significant difference in recovery period between the two groups（P〈0.05）, systolic blood pressure, diastolic blood pressure and heart rate of the study group in recovery period were significantly lower than those in the control group, the incidence of irritability in recovery period was significantly lower than that in control group, the difference was statistically significant（P〈0.05）. There was no significant difference in blood glucose, cortisol and epinephrine in the two groups before operation（P〈0.05）. At 72 h after operation,the blood glucose, cortisol and epinephrine were increased in the two groups（P〈0.05）, the blood glucose, cortisol and epinephrine in the study group were significantly lowe than those in the control group, the difference was statistically significant（P〈0.05）. Conclusion： The application of epidural combined with general anesthesia in thoracic surgery can significantly improve the awakening quality during recovery period, stabilize hemodynamics, and improve their stress response.