高海拔地区≥70岁老年人术中腰硬联合麻醉的应用效果及安全性分析

Analysis of the Effect and Safety of Combined Spinal and Epidural Anesthesia in the Elderly Aged ≥70 Years Old in High Altitude Area

目的:探讨高海拔地区≥70岁以上老年人术中腰硬联合麻醉(CSEA)的应用效果及安全性。方法:选取在海拔3200米及以上地区居住二十年及以上,年龄≥70岁拟行下肢或下腹部或会阴部手术的老年患者240例进行CSEA。分别在麻醉前、切片时和手术结束时监测并记录血浆肾素(PRA)、血管紧张素Ⅱ(ATⅡ)、醛固酮(ALD)、皮质醇(COR)、胰岛素(INS)、生长素(GH)、血糖(GLU)浓度以及无创血压(NBP)、心电图(ECG)、心率(HR)、脉搏氧饱和度(SPO2)。对比不同时期患者的体内激素水平,并分别比较不同年龄、不同性别及有无呼吸系统疾病病史对患者体内激素水平的影响。结果:麻醉前、切片时及手术后的INS、GH、GLU、COR、ALD、PRA及AT-Ⅱ水平比较差异无统计学意义(均P>0.05)。不同年龄组,不同性别组及不同呼吸系统疾病病史组各时期INS、ALD、GH、COR、PRA、AT-Ⅱ、GLU水平水平比较差异均无统计学意义(均P>0.05)。结论:CSEA对循环影响小,阵痛完善,安全有效,对老年患者血流动力学影响小,并能一定程度上抑制手术造成的应激反应,适用高海拔地区老年病人手术中的麻醉。

Objective: To investigate the effect and safety of combined spinal and epidural anesthesia(CSEA) in the elderly aged≥70 years old at high altitude area. Methods: a total of 240 elderly patients who have lived in the area of 3200 meters above sea level for 20 years or more and who were ≥70 years old were selected for CSEA. Plasma renin(PRA), angiotension Ⅱ(ATⅡ), aldosterone(ALD), cortisol(COR), insulin(INS), growth hormone(GH), blood glucose(GLU), noninvasive blood pressure(NBP), electrocardiogram(ECG), heart rate(HR) and pulse oxygen saturation(SPO2) were monitored and recorded before anesthesia, slicing time and at the end of operation. To compare the hormone levels of patients in different periods, and to compare the effects of different age, gender and history of respiratory diseases on the hormone levels of patients. Results: There was no significant difference in INS, GH, GLU, COR,ALD, PRA and ATⅡ levels before anesthesia, slicing time and postoperative(P>0.05). There was no significant difference in the levels of INS, GH, GLU, COR, ALD, PRA and ATⅡ in different age groups, different gender groups and different respiratory disease history groups(P>0.05). Conclusion: CSEA has little effect on circulation, perfect pain, safety and efficiency, little effect on hemodynamics of elderly patients, and can inhibit the stress response caused by operation to a certain extent, which is suitable for anesthesia in operation of elderly patients in high altitude areas.