单侧腰麻对老年髋关节置换手术应激反应影响的研究  

The research on stress response of unilateral lumbar anesthesia in hip replacement operation in senile patients

作　　者：彭明清[1] 李敏[1] 李远[2] 彭强[1] 黄厚刚[1] 

机构地区：[1]重庆医科大学附属永川医院麻醉科,402160 [2]重庆医科大学附属永川医院中心实验室,402160

出　　处：《重庆医学》2012年第22期2258-2259,2262,共3页Chongqing medicine

摘　　要：目的观察单侧腰麻在老年髋关节置换手术应用的麻醉效果及对机体应激反应的影响。方法选取该院年龄70～94岁,ASA分级Ⅱ～Ⅲ级行髋关节置换手术的患者40例,随机分成分两组,单侧腰麻组(A组)和常规腰麻组(B组),分别评定麻醉效果,记录两组给药前、后各时段生命体征、起效时间、阻滞平面及麻醉维持时间,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)和皮质醇(CORT)的浓度。结果两组患者麻醉前生命体征无明显差异,术中麻醉镇痛效果均满意。B组血压下降较A组血压下降明显(P<0.05),A组腰麻用药量较B组用药少(P<0.05),两组患者麻醉起效时间、麻醉平面及维持时间无显著差异(P>0.05),术毕及术后24h的NE、E和CORT的浓度A组均低于B组(P<0.05)。结论单侧腰麻在老年髋关节置换手术应用中用药量小,麻醉效果好,对手术和麻醉的应激反应小,对生命体征影响小,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 unilateral lumbar anesthesia.Methods Forty ASA Ⅱ~Ⅲ patients aged 70-94 years were randomly divided into two groups：group A（unilateral lumbar anesthesia group） and group B（subarachnoid anaesthesia group）.The anaesthetic effect was measured and the vital signs,level of anesthesia,and main tenance 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 noradrenaline,adrenaline and cortisol.Results There were no obvious difference of vital signs before anesthesia and the analgesia effect of anesthesia were satisfied in two groups,There was no difference in the on set time and main tenance times and level of anesthesia between two groups（P〉0.05）.The blood pressure in group B droped down significantly than group A（P〈0.05） and the dose of bupivacaine in group A was less than group B（P〈0.05）.The level of NE,E and CORT in group A was lower than that in group B（P〈0.05）.Conclusion Unilateral lumbar anesthesia is a feasible and safe anesthesia method which causes no harmful effects on hip replacement operation in senile patients and can relieve the stress responses.

关 键 词：单侧腰麻 髋关节置换手术 应激反应 老年人 

分 类 号：R614[医药卫生—麻醉学]