轻比重腰硬联合麻醉对老年下肢骨科手术患者应激反应的影响

The Effect of Light Specific Gravity and Spinal Epidural Combined with Anesthesia on the Stress Response of Elderly Patients Undergoing Orthopedic Surgery on Lower Extremities

目的:探讨轻比重腰硬联合麻醉对老年下肢骨科手术患者应激反应的影响。方法:选取福州市晋安区医院2019年3月至2020年8月期间收治的98例下肢骨科手术老年患者,随机均分为甲组(气管插管全身麻醉)和乙组(轻比重蛛网膜下腔阻滞联合硬膜外麻醉),各49例。观察两组患者在麻醉前(T0)、麻醉中(T1)、麻醉30 min后(T2)、拔管后(T3)的血压和应激反应。结果:两组患者的收缩压(SBP)和舒张压(DBP)在T1、T2时均低于T0时,且两组患者SBP、DBP在T2时均低于T1时,差异均具有统计学意义(P<0.05),且甲组患者SBP、DBP在T1、T2时与乙组比较,差异均具有统计学意义(P<0.05);两组患者的促肾上腺皮质激素(ACTH)、皮质醇(Cor)及β-内啡肽(β-EP)在T1、T2时均高于T0时,且两组患者ACTH、Cor及β-EP在T2时均低于T1时,差异均具有统计学意义(P<0.05)。且甲组患者ACTH、Cor及β-EP在T1、T2时与乙组比较,差异均具有统计学意义(P<0.05)。结论:老年下肢骨科手术患者采用轻比重蛛网膜下腔联合硬膜外麻醉可显著减少患者术中应激反应,对患者循环影响较小,安全性较好。

Objective To explore the effect of light specific gravity combined spinal-epidural anesthesia on the stress response of elderly patients undergoing orthopedic surgery on the lower extremities.Methods A total of 98 elderly patients undergoing orthopedic surgery on lower limbs were selected from Jinan District Hospital of Fuzhou from March 2019 to August 2020.They were randomly divided into group A(tracheal intubation general anesthesia)and group B(light specific gravity arachnoid membrane).Inferior cavity block combined with epidural anesthesia),49 cases in each case.Observe the blood pressure and stress response of the two groups of patients before anesthesia(T0),during anesthesia(T1),30 minutes after anesthesia(T2),and after extubation(T3).Results The systolic blood pressure(SBP)and diastolic blood pressure(DBP)of the two groups were lower than T0 at T1 and T2,and the SBP and DBP of the two groups were lower than T1 at T2.The differences were statistically significant.(P<0.05),and compared with group B in SBP and DBP at T1 and T2,the difference was statistically significant(P<0.05);the adrenocorticotropic hormone(ACTH)and cortisol(Cor)andβ-endorphin(β-EP)are higher than T0 at T1 and T2,and ACTH,Cor andβ-EP of the two groups are lower than T1 at T2,the differences are statistically significant(P<0.05).In addition,the ACTH,Cor andβ-EP of group A patients were compared with group B at T1 and T2,and the differences were statistically significant(P<0.05).Conclusion The use of light specific gravity subarachnoid combined with epidural anesthesia in elderly patients undergoing orthopedic surgery for lower extremities can significantly reduce the stress response during the operation,with less impact on the circulation of patients,and better safety.