摘要
目的分析不同麻醉方式对腹腔镜胆囊切除术（Lc）的老年患者应激反应及血流动力学的影响。方法选择需行Lc的老年患者58例，按随机数字表法分为全身麻醉复合硬膜外麻醉组（GAEA组），单纯全身麻醉组（GA组），每组29例，观察患者应激反应及血流动力学变化。结果两组气腹时血压及心率（HR）升高，气腹后30minGAEA组基本恢复，GA组恢复较慢；两组麻醉前及麻醉后收缩压（SBP）、舒张压（DBP）、HR比较差异无统计学意义（P〉0．05），GAEA组气腹时SBP、DBP、HR分另0为（123．8±25．9）mmHg（1mmHg=0．133kPa）、（85．9±8．4）mmHg、（83．2±7．4）次／min，气腹后10min分别为（118．2±21．1）mmHg、（84．4±8．3）mmHg、（82．8±7．5）次／min，气腹后30min分别为（114．9±20．7）mmHg、（80．2±7．6）mmHg、（78．5±10．4）次／min，GA组气腹时SBP、DBP、HR分别为（138.3±26．7）mmHg、（91．2±8．8）mmHg、（89．3±10．1）次／min，气腹后10min分别为（130．3±21．3）mmHg、（89．2±8．6）mmHg、（88．2±9．7）次／min，气腹后30min分别为（126．2±20．7）mmHg、（85．2±8．4）mmHg、（84．9±9．6）次／min，两组气腹时、气腹后10min、气腹后30minSBP、DBP、HR比较差异有统计学意义（P〈0．05）；GAEA组麻醉起效时间（73．2±24．9）s，术后清醒时间（31．6±10。2）min，GA组分别为（78．1±22．4）s、（35．9±14．3）min，GAEA组麻醉起效时间及术后清醒时间较GA组短，但两组比较差异无统计学意义（P〉0．05）；GAEA组术后疼痛视觉模拟评分（13．4±8．2）分，明显低于GA组的（26．3±10．1）分，两组比较差异有统计学意义（P〈0．05）；GAEA组不良反应发生率为27．59％（8，29），GA组不良反应发生率为6．90％（2／29），两组比较差异有统计学意义（P〈0．05）。结论老年患者行Lc时采用全身麻醉复合硬膜外麻醉较单纯全身麻醉能减少术中应激反应的发生，血流动力学较为稳定，麻醉效果好，苏醒较快，但相对可能增加患者术后恶心、头痛等不良反应的发生率。
Objective To analyze the influence of different anesthesia methods on the stress response and hemodynamic of elderly patients undergoing laparoscopic cholecystectomy (LC).Methods Fifty-eight elderly patients who needed LC were selected and divided by random digits table method into GAEA group received general anesthesia combined with epidural anesthesia and GA group received general anesthesia with 29 cases each.The stress response and changes of hemodynamic were observed.Results Blood pressure and heart rate (HR) were elevated during pneumoperitoneum in both groups.Blood pressure and HR returned to normal at 30 minutes after pneumoperitoneum in GAEA group,which were recovered more slowly in GA group.There was no significant difference in systolic blood pressure (SBP),diastolic blood pressure (DBP),HR between two groups before and after anesthesia (P＞0.05).SBP,DBP,HR of GAEA group were ( 123.8 ± 25.9) mm Hg ( 1 mm Hg =0.133 kPa),(85.9 ± 8.4) mm Hg,(83.2 ± 7.4) times/min during pneumoperitoneum,respectively,(118.2 ±21.1) mm Hg,(84.4 ±8.3) mm Hg,(82.8 ±7.5)times/min at 10 min after pneumoperitoneum,( 114.9 ± 20.7) mm Hg,(80.2 ± 7.6) mm Hg,(78.5 ± 10.4)times/min at 30 min after pneumoperitoneum.SBP,DBP,HR of GA group were (138.3 ±26.7) mm Hg,(91.2 ± 8.8) mm Hg,(89.3 ± 10.1 ) times/min during pneumoperitoneum,( 130.3 ± 21.3) mm Hg,(89.2 ±8.6) mm Hg,(88.2 ± 9.7) times/min at 10 min after pneumoperitoneum,( 126.2 ± 20.7) mm Hg,(85.2 ±8.4) mm Hg,(84.9 ± 9.6 ) times/min at 30 min after pneumoperitoneum,respectively.SBP,DBP,HR during pneumoperitoneum,at 10 min and 30 min after pneumoperitoneum in two groups had significant differences (P ＜0.05).The anesthesia onset time in GAEA group was (73.2 ±24.9) s,and the awake time after operation was (31.6 ± 10.2) min,while those in GA group were (78.1 ± 22.4) s and (35.9 ± 14.3) min.The anesthesia onset time and awake time after operation in GAEA group were shorter than those in GA group,but had no significant difference (P＞ 0.05 ).Postoperative visual analogue score of GAEA group [ ( 13.4 ± 8.2)scores] was obviously lower than that of GA group [(26.3 ± 10.1) scores] (P ＜0.05).The incidence of adverse reactions between GAEA group [27.59％(8/29)] and GA group [6.90％(2/29)] had statistical difference (P ＜ 0.05).Conclusions Compared with general anesthesia,general anesthesia combined with epidural anesthesia during LC for elderly patients can reduce the occurrence of intraoperative stress responses and have more steady hemodynamic,better anesthetic effect and faster recovery.But it may cause the incidence of nausea,headache and other postoperative adverse reactions increase.
出处
《中国医师进修杂志》
2012年第20期15-18,共4页
Chinese Journal of Postgraduates of Medicine
