不同麻醉方式对老年开胸肺癌根治术患者的应激水平及血流动力学的影响

Effects of different anesthesia methods on stress level and hemodynamics in elderly patients undergoing thoracotomy and radical resection of lung cancer

目的探讨三种麻醉方式对老年开胸肺癌根治术患者的应激水平、炎症及血流动力学的影响。方法选择2017年1月至2019年1月深圳市人民医院行开胸肺癌根治手术的老年患者90例,按照随机数表法将患者随机分为A、B、C组三组,每组30例。A组给予全凭静脉麻醉、B组给予吸入麻醉、C组给予硬膜外复合全身麻醉。分别于麻醉前后采集三组患者静脉血标本检测患者去甲肾上腺素(NE)、肾上腺素(E)、皮质醇(Cor)、C反应蛋白(CRP)、肿瘤坏死因子水平(TNF-α),检测手术前后三组患者心率(HR)、平均动脉压(MAP)、心排血量(CO)、全心舒张末期容量指数(GEDVI)。结果在插管时、拔管时、拔管后30 min,三组患者的NE、E、Cor水平均明显高于麻醉前,差异均有统计学意义(P<0.05),其中A、B组上述指标在插管时、拔管时、拔管后30 min明显高于C组,差异均有统计学意义(P<0.05);与术前相比,三组患者术后1 h、术后24 h、术后72 h的CRP、TNF-α均明显升高,差异均有统计学意义(P<0.05),其中A、B组患者的上述指标明显高于C组,差异均有统计学意义(P<0.05);与麻醉诱导前比较,三组患者在插管时、拔管时的HR、MAP均明显下降,差异均有统计学意义(P<0.05);拔管30 min后,A、B组患者的HR、MAP水平明显低于C组,差异均有统计学意义(P<0.05),但C组患者的血流动力学与麻醉前水平基本一致,差异均无统计学意义(P>0.05)。结论对老年开胸肺癌根治术患者行硬膜外复合全身麻醉可明显减轻应激、炎症反应,且术中血流动力学稳定,可作为临床推荐的麻醉方法。

Objective To investigate the effects of three anesthesia methods on stress level, inflammation and hemodynamics in elderly patients undergoing thoracotomy and radical resection of lung cancer. Methods From January 2017 to January 2019, 90 elderly patients (aged over 65 years) who underwent thoracotomy for lung cancer in Shenzhen People's Hospital were randomly divided into groups A, B and C, with 30 in each group. Group A was given total intravenous anesthesia, group B was given inhalation anesthesia, and group C was given combined general-epidural anesthesia. The levels of norepinephrine (NE), epinephrine (E), cortisol (Cor), C-reactive protein (CRP), and tumor necrosis factor-alpha (TNF-α) were measured before and after anesthesia, as well as heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), and global end-diastolic volume index (GEDVI). Results The levels of NE, E and Cor in group A, B and C at intubation, extubation and 30 minutes after extubation were significantly higher than those before anesthesia (P<0.05), and those in group A and B at intubation, extubation and 30 minutes after extubation were significantly higher than those in group C (P<0.05). Compared with pre-operation, CRP and TNF-α in group A, B and C increased significantly at 1 hour, 24 hours and 72 hours after operation (P<0.05), and the above-mentioned indexes in group A and B were significantly higher than those in group C (P<0.05). Compared with before induction of anesthesia, HR and MAP decreased significantly in group A, B and C during intubation and extubation, the difference were statistically significant(P<0.05). 30 minutes after extubation, the HR and MAP levels of group A and B were significantly lower than those of group C (P<0.05), and the hemodynamics of group C was basically the same as that before anesthesia (P>0.05). Conclusion Epidural combined general anesthesia can significantly reduce stress and inflammation in elderly patients undergoing thoracotomy and radical resection of lung cancer, and the hemodynamics of the patients is stable which can be used as a recommended anesthetic method in clinic.