外周神经阻滞与腰-硬联合麻醉对老年高血压患者下肢手术应激反应的影响

发布时间：2018-07-13 19:14

【摘要】：目的:探讨外周神经阻滞与腰-硬联合麻醉对老年高血压患者下肢手术患者应激反应的影响。方法:96例拟行单侧下肢手术合并高血压的老年患者,按随机数字表法分为试验组和对照组,各48例。试验组患者采用盐酸罗哌卡因注射液15~25ml外周神经阻滞麻醉,对照组组采用盐酸布比卡因注射液1.2~1.8 ml腰-硬联合麻醉。观察两组患者的手术时间、麻醉起效时间、阻滞完善时间及术前(T_0)、切皮时(T_1)、术中(T_2)、术毕拔管(T_3)时的心率(HR)、平均动脉压(MAP)、血氧饱和度(Sp O2)、肾上腺素(E)、去甲肾上腺素(NE)、血清白细胞介素(IL)6、血清皮质醇(COR)的变化情况。结果:对照组患者的麻醉起效时间、阻滞完善时间均显著低于试验组,差异有统计学意义(P0.05)。两组患者的T_0、T_1、T_2、T_3时的HR、Sp O2比较,差异无统计学意义(P0.05);对照组患者T_1、T_2、T_3时的MAP均显著低于试验组,差异有统计学意义(P0.05)。两组患者T_0时E、NE、IL-6、COR水平比较,差异无统计学意义(P0.05);对照组患者T_1、T_2、T_3时的E、NE、IL-6、COR水平均高于试验组(P0.05)。结论:与硬-腰联合麻醉相比,外周神经阻滞麻醉对拟行单侧下肢手术合并高血压的老年患者麻醉效果较好,循环波动影响小、应激反应轻。
[Abstract]:Objective: to investigate the effects of peripheral nerve block and combined spinal-epidural anesthesia on stress response in elderly hypertensive patients undergoing lower extremity surgery. Methods Ninety-six elderly patients with unilateral lower extremity operation and hypertension were randomly divided into two groups: experimental group (n = 48) and control group (n = 48). The patients in the test group were anesthetized with ropivacaine hydrochloride injection 15~25ml peripheral nerve block, and the control group were treated with 1. 21ml bupivacaine hydrochloride injection combined with epidural anesthesia. The operative time and the effective time of anesthesia were observed in the two groups. The changes of heart rate (HR), mean arterial pressure (map), blood oxygen saturation (SPO _ 2), epinephrine (E), norepinephrine (NE), serum interleukin (IL) 6, serum cortisol (COR) were observed before and after operation. Results: the onset time of anesthesia and the time of block improvement in the control group were significantly lower than those in the experimental group (P0.05). There was no significant difference between the two groups (P0.05) in the comparison of HRSpO2 at the time of T0 / T _ 1 / T _ 2C _ (3) in the two groups, but the map in T _ (1) / T _ (2) / T _ (3) in the control group was significantly lower than that in the test group (P0.05). There was no significant difference in the level of IL-6 cor between the two groups at the time of T _ 0 (P0.05); in the control group, the level of IL-6 / cor in T _ 1 / T _ 2 / T _ 3 was higher than that in the test group (P0.05). Conclusion: compared with combined epidural and lumbar anesthesia, peripheral nerve block anesthesia has a better effect on the elderly patients undergoing unilateral lower extremity surgery with hypertension, and has less effect on circulation fluctuation and less stress response.
【作者单位】：佛山市高明区人民医院麻醉科;
【基金】：2013年佛山市科学技术局医学类科技攻关项目(No.201308325)
【分类号】：R614

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