不同麻醉方法对老年患者行腹腔镜胆囊切除术应激反应的影响

发布时间：2018-05-21 09:52

本文选题：腹腔镜胆囊切除术 + 老年人　；参考：《宁夏医学杂志》2016年09期

【摘要】：目的探讨全麻与硬膜外复合全麻对老年患者腹腔镜下胆囊切除手术应激反应的影响。方法选择ASAⅠ~Ⅲ级60例老年择期腹腔镜胆囊切除术手术患者为研究对象,分为单纯全麻组(GA组,n=30)和硬膜外复合全麻组(GEA组,n=30)。GA组患者全麻诱导:咪唑安定0.05 mg/kg,丙泊酚0.5~1.5 mg/kg、舒芬太尼0.3~0.5μg/kg和阿曲库铵0.2 mg/kg,给氧去氮3 min后置入3号或4号喉罩;GEA组先选择T8~9穿刺置管后给予1%利多卡因3 m L,再用DA组同样方法进行全麻诱导。麻醉维持GA组以瑞芬太尼0.10~0.20μg/(kg·min),丙泊酚3~5 mg/(kg·h);GEA组以1%利多卡因+0.2%罗派卡因混合液5~10 m L和丙泊酚3~5 mg/(kg·h)维持麻醉。2组术中观察并记录患者麻醉诱导前(T0)、气腹后即刻(T1)、气腹后30 min(T2)及手术结束(T3)抽取静脉血检测患者肾上腺素、去甲肾上腺素及血浆皮质醇浓度,记录T0、T1、T2及T3的心率(HR)、收缩压(SBP)、舒张压(DBP)和脉搏血氧饱和度(SPO2)等生命体征;在麻醉复苏期间观察2组患者的苏醒质量。结果 GE组肾上腺素、去甲肾上腺素、血浆皮质醇浓度在,T2、T3明显高于GEA组(P0.05);2组患者肾上腺素、去甲肾上腺素、血浆皮质醇高于术前(P0.05);GEA组HR、SBP、DBP在术中较GE组平稳,2组间差异有统计学意义(P0.05);苏醒质量GEA组好于GE组(P0.05)。结论在老年人行腹腔镜手术中,硬膜外复合全麻能够更好地抑制交感神经,减轻应激反应,且苏醒质量好。
[Abstract]:Objective to investigate the effect of general anesthesia and epidural general anesthesia on the stress response of laparoscopic cholecystectomy in elderly patients. Methods 60 elderly patients with ASA I ~ III were selected as the subjects of laparoscopic cholecystectomy, and were divided into general anesthesia group (group GA, n=30) and epidural complex general anesthesia group (group GEA, n=30).GA. Guide: midazolam 0.05 mg/kg, propofol 0.5~1.5 mg/kg, sufentanil 0.3~0.5 mu g/kg and atracurium 0.2 mg/kg, oxygen removal nitrogen 3 min into 3 or 4 laryngeal mask; GEA group first selected T8~9 puncture catheterization to give 1% lidocaine 3 m L, and then DA group the same method for general anesthesia induction. Anesthesia maintenance group with remifentanil ), propofol 3~5 mg/ (kg. H), GEA group with 1% lidocaine +0.2% ropivacaine 5~10 m L and propofol 3~5 mg/ (kg.) to observe and record the patients before anesthesia induction, immediately after pneumoperitoneum, 30 after pneumoperitoneum and surgical bundles to detect epinephrine, norepinephrine and plasma The concentration of cortisol, recorded the heart rate (HR), systolic pressure (SBP), diastolic pressure (DBP) and pulse oxygen saturation (SPO2) of T0, T1, T2 and T3, and observed the awakening quality of the 2 groups during the anaesthesia. Results the concentration of adrenaline, norepinephrine, plasma cortisol in the GE group, T2, T3 was significantly higher than that of the GEA group; the 2 group of adrenaline was adrenalin Norepinephrine, plasma cortisol was higher than that before operation (P0.05), HR, SBP, DBP in group GEA were more stable than group GE, and there was a significant difference between the 2 groups (P0.05); the quality of awakening GEA was better than group GE (P0.05). Conclusion epidural combined general anesthesia can better inhibit sympathetic nerve, relieve stress response, and revive in elderly patients undergoing laparoscopic surgery. Good quantity.
【作者单位】：宁夏吴忠市人民医院麻醉科;宁夏吴忠市人民医院护理部;宁夏医科大学总医院麻醉科;
【分类号】：R614.27

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