不同麻醉方法对老年骨科手术患者应激反应的影响  

Influence of different anesthesia on stress responses of senile patients in orthopaedics

作　　者：刘晓峰[1] 姚立农[1] 柴伟[1] 梁峰[2] 杨永慧[1] 

机构地区：[1]第四军医大学附属唐都医院麻醉科,陕西省西安市710038 [2]解放军第四○一医院麻醉科,山东省青岛市266071

出　　处：《实用老年医学》2006年第5期309-311,共3页Practical Geriatrics

摘　　要：目的 观察腰-硬联合麻醉在老年患者下肢手术的麻醉效果及其对机体应激反应的影响。方法 选年龄69—91岁，按美国麻醉医师学会（ASA）分级Ⅰ-Ⅱ级行骨科手术的患者48例，分2组，对照组（Ⅰ组）硬膜外麻醉，试验组（Ⅱ组）腰-硬联合麻醉。分别评定麻醉效果，记录2组给药前后多时段生命体征、起效时间、阻滞平面及维持时间，分别于术前、术毕和术后24h采集静脉血，测定血浆去甲肾上腺素（NE）、肾上腺素（E）的浓度。结果 2组患者麻醉前后生命体征无明显变化，起效时间Ⅱ组明显快于I组（P〈0．05），各时段NE和E的浓度Ⅰ组均高于Ⅱ组（P〈0．05），术中镇痛效果的满意度Ⅱ组（96％）明显高于Ⅰ组（74％）。结论 只要术前准备充分，掌握给药的剂量和速度，腰-硬联合麻醉对老年患者不会产生不良影响，且可减轻手术的应激反应，是一种效果好而可行的麻醉方法。Objective To investigate the anaesthetic effect and the changes of stress responses in senile patients undergoing combined spinal-epidural anesthesia. Methods Forty-eight ASA Ⅰ - Ⅱ patients aged 69-91 years were randomly divided into two groups ： CEA group（ group Ⅰ ）and CSEA group （group Ⅱ）. The anaesthetic effect was measured and the vital signs, level of anesthesia, and maintenance times in different stages were recorded. Venous blood was taken before anesthesia,at the end of operation and 24 hours after operation for determination of plasma adrenaline and noradrenaline. Results There was no change of vital signs before and after anesthesia. The effect of anesthesia was significantly earlier in group Ⅱ than that in group Ⅰ （P 〈0. 05）. There was no difference in level of anesthesia. The level of NA and A in group Ⅰ was higher than that in group Ⅱ （P 〈 0.05 ）. The analgesia effect of group Ⅱ was better than that of group Ⅰ. Conclusions Combined spinal-epidural anesthesia is a feasible anesthesia method if the patients are prepared thoroughly and the dose and speed of administration of drug are appropriate. Combined spinal-epidural anesthesia causes no harmful effects on senile patients and can relieve the stress responses.

关 键 词：麻醉 硬膜外 骨骼 外科手术 应激 老年人 

分 类 号：R614.4[医药卫生—麻醉学] R687.3[医药卫生—外科学]