硬膜外麻醉复合全身麻醉对老年腹部手术患者心肌损伤及凝血纤溶系统的影响

Effects of epidural anesthesia combined with general anesthesia on myocardial injury and coagulation and fibrinolysis system in elderly patients undergoing abdominal surgery

目的:分析老年腹部手术患者应用硬膜外麻醉复合全身麻醉后心肌损伤情况及凝血纤溶系统变化。方法:选取我院2018年3月至2019年3月期间收治的103例老年腹部手术患者,依据随机单双号抽签法分为对照组(n=51)及观察组(n=52)。对照组患者应用舒芬太尼、咪唑安定、罗库溴铵、丙泊酚进行全身麻醉,观察组患者先于T10-T12椎间隙穿刺置管,注入5 m L利多卡因,5 min后给予利多卡因、布比卡因混合液10 m L间断注入,感觉阻滞达T6平面后,给予舒芬太尼、咪唑安定、罗库溴铵、丙泊酚进行全身麻醉。观察两组患者麻醉前、后凝血纤溶系统指标水平及心肌损伤指标水平变化,并对比两组患者麻醉中麻醉药物用量及不良事件发生率。结果:观察组术后6 h心肌肌钙蛋白I(Cardiac troponin I,cTnI)、凝血酶时间(Thrombin time,TT)、肌酸激酶同工酶(Creatine kinase isoenzymes,CK-MB)水平明显低于对照组(P<0.05),术后12 h cTnI、纤维蛋白原(Fibrinogen,FIB)、CK-MB水平低于对照组(P<0.05)。丙泊酚、维库溴铵、舒芬太尼用量及不良事件发生率低于对照组(P<0.05)。结论:硬膜外麻醉复合全身麻醉能够有效降低老年腹部手术患者凝血纤溶系统的影响,减轻心肌损伤,减少麻醉用药,术后并发症发生率低。

Objective:To investigate the effects of epidural anesthesia combined with general anesthesia on the myocardial injury and the changes of the coagulation and fibrinolysis system in elderly patients undergoing abdominal surgery.Methods:All together,103 elderly patients with abdominal surgery admitted to our hospital from March 2018 to March 2019 were randomly divided into the control group(n=51)and the observation group(n=52).Patients in the control group underwent general anesthesia with sufentanil,midazolam,rocuronium bromide,and propofol.Patients in the observation group were treated with T10-T12 intervertebral space puncture.And lidocaine 5 m L was given 5 min later.10 m L of lidocaine and bupivacaine mixture was injected intermittently.After the sensory block reached the T6 plane,general anesthesia was induced with sufentanil,midazolam,rocuronium bromide and propofol.The level of post-coagulation,fibrinolysis system,myocardial injury index,the anesthetic dosage,and adverse event rate in anesthesia was compared between the two groups.Results:Cardiac troponin I(cTnI),thrombin time(TT),and creatine kinase isoenzymes(CK-MB)levels in the observation group were significantly lower than those in the control group(P<0.05).The levels of c Tn I,fibrinogen(FIB)and CK-MB in the observation group were less than the control group at 12 h after operation(P<0.05).The amount of Propofol,vecuronium bromide and sufentanil,and the incidence of adverse events in the observation group were lower than those of the control group(P<0.05).Conclusion:Epidural anesthesia combined with general anesthesia effectively reduces the influence of the coagulation and fibrinolysis system in elderly patients with abdominal surgery,decrease myocardial damage,and has a low incidence of postoperative complications.