硬膜外麻醉联合全身麻醉对老年高血压患者血流动力学和应激反应的影响

Effects of Epidural Anesthesia Combined with General Anesthesia on Hemodynamics and Stress Response in Elderly Patients with Hypertension

目的 :探讨硬膜外麻醉联合全身麻醉对老年高血压患者血流动力学和应激状态的影响。方法 :选取自2014年1月~2017年1月期间收治的118例腹腔镜下胆囊切除术的老年高血压患者为研究对象,随机分为A组和B组各59例。A组采用全身麻醉,B组采用硬膜外麻醉联合全身麻醉。对比两组患者麻醉前(T0)、插管后(T1)、建立人工气腹后10min(T2)、拔管前(T3)的收缩压(SBP)、舒张压(DBP)、心率(HR)以及血氧饱和度(Sp O2);对比两组患者T0、T1、T2、T3的生长激素(GH)、催乳素(PRL)、皮质醇(Cor)的变化情况;对比两组患者术后呼吸恢复时间、睁眼时间、拔管时间;对比两组患者苏醒期烦躁发生率。结果 :两组T1、T2、T3的SBP、DBP、HR均显著高于T0;B组T1、T2、T3的SBP、DBP均显著低于A组,而HR均显著高于A组;B组T1、T2、T3的GH、PRL、Cor均显著低于A组;B组术后呼吸恢复时间、睁眼时间和拔管时间均显著少于A组;B组苏醒期烦躁的发生率为6.78%,显著低于A组。结论 :硬膜外麻醉联合全身麻醉更有利于维持老年高血压手术患者血流动力学的稳定,减轻患者的应激反应,缩短术后恢复时间。

Objective To investigate the effect of epidural anesthesia combined with general anesthesia on hemodynamics and stress status in elderly patients with hypertension. Methods One hundred and eighteen elderly patients with hypertension treated by laparoscopic cholecystectomy from January 2014 to January 2017 were selected, and were randomly divided into group A and group B, fifty-nine cases in each. General anesthesia was used in group A, while epidural anesthesia combined with general anesthesia was used in group B. The systolic blood pressure(SBP), diastolic blood pressure(DBP), heart rate(HR) and oxygen saturation(Sp O2) before anesthesia(T0), after intubation(T1), 10 min after pneumoperitoneum(T2), and before extubation(T3) were compared between the two groups. The levels of growth hormone(GH), prolactin(PRL) and cortisol(Cor) in T0, T1, T2 and T3 were compared between the two groups. The breathing recovery time, awake time and extubation time after operation were compared between the two groups. The incidence of emergence delirium were compared between the two groups. Results The SBP, DBP and HR of the two groups in T1, T2 and T3 were significantly higher than those in T0. The SBP and DBP of group B in T1 T2 and T3 were significantly lower than those of group A, while the HR was significantly higher than that of group A. The levels of GH, PRL and Cor of group B in T1, T2 and T3 were significantly lower than those of group A. The breathing recovery time, awake time and extubation time after operation of group B were significantly less than those of group A. The incidence rate of emergence delirium of group B was 6.78%, which was significantly lower than that of group A. Conclusion Epidural anesthesia combined with general anesthesia is more conducive to maintaining the stability of hemodynamics in elderly patients with hypertension. It can reduce the stress response and shortening the postoperative recovery time.