全麻复合硬膜外阻滞行腹腔镜胆囊切除术对老年患者应激反应的影响  

Effect of General Anesthesia Combined with Epidural Block on Stress Responses in Elderly Patients Undergoing Laparoscopic Cholecystectomy

作　　者：吴静波[1] 蔡杰衡[1] 吴志镇[1] 

机构地区：[1]广东药学院附属第一医院麻醉科,广东广州510080

出　　处：《临床医学工程》2013年第10期1228-1230,共3页Clinical Medicine & Engineering

摘　　要：目的研究全麻复合硬膜外阻滞行腹腔镜胆囊切除术对老年患者应激的影响，为全麻复合硬膜外麻醉的临床应用提供理论依据。方法40例ASAI-Ⅱ级择期行腹腔镜胆囊切除手术病人（年龄〉65岁），随机双盲分为全麻组（A组）和全麻复合硬膜外阻滞组（B组），每组20例。并于麻醉前（T1），气管插管后5min（T2），气腹后5min（T3），术毕前5min（T4），拔管后5min（T4）抽静脉血，检测血浆标本中血糖浓度、皮质醇、血管紧张素Ⅱ、白介素-6（IL-6）。采用SPSS10．0及SigmaPlot统计绘图软件分析处理数据。结果A组血流动力学气管插管后较B组波动大（P〈0．C5）。A组在T2、T3、T5时血糖浓度显著高于B组（P〈0．05）。两组血管紧张素II在麻醉后各时间段相比有显著性差异（P〈0．05）；两组T4、T5的IL-6浓度均明显高于T2时的水平（P〈0．05）；组间比较，B组T4、T5时IL-6的浓度明显低于A组（P〈0．05）。结论全麻复合硬膜外阻滞组对老年患者应激反应的影响小于全麻组。Objective To evaluate the efficacy of general anesthesia combined with epidural block on stress responses in elderly patients undergoing laparoscopic cholecystectomy. Methods Forty patients （〉65 years old, ASA Ⅰ - Ⅱ ） with laparoscopic cholecystectomy were randomly divided into two groups： group A （general anesthesia, n = 20） and group B （general anesthesia combined with epidural anesthesia, n = 20）. The plasma contents of Blood sugar （BS）, cortisol, angiotensin Ⅱ （Ag- Ⅱ ） Interleukin-6 at the following time points of before anesthesia （T1）, after 5 min intubation （T2）, 5 min after the artificial pneumoperitoneum （T3）, before the operation finished time （T4） and after extubation （TS） were measured. Results In group A, MAP, HR at the time ofT2, T3 and T4 was higher than that in group B （P〈0.05）. The level of plasma glucose in group B at time of T4, T5 was higher than the level before anesthesia （P 〈0.05）. The level of plasma cortisol in the two groups at various time was significantly lower than the levels at time of T2 （P〈0.05）. The level of plasma Ag- H in group A at time ofT2, T3, T4 and T5 was significantly higher than that in group B （P〈0.05）. The level of plasma Interleukin-6 in the group B at time of T4, T5 was significantly lower than level of plasma Interleukin-6 in the group A （P 〈0.05）. Conclusions General anesthesia combined with epidural block for laparoscopic cholecystectomy in elderly patients can reduce the organism stress response.

关 键 词：硬膜外阻滞 全身麻醉 皮质醇 血管紧张素Ⅱ 白介素-6 

分 类 号：R614[医药卫生—麻醉学]