全麻复合硬膜外麻醉对老年腹部手术后患者细胞因子及安全性分析  

Analysis of cytokines and safety of combined general and epidural anesthesia in elderly patients after abdominal surgery

作　　者：周蔚蓝[1] 周惠芬[2] 徐恒艺[2] 钱玉芳[2] ZHOU Wei - lan;ZHOU Hui - fen;XU Heng - yi;QIAN Yu - fang(Department of Anesthesiology, Jinhua Central Hospital, Jinhua, Zhejiang 321000, China)

机构地区：[1]金华市中心医院麻醉科,浙江金华321000 [2]湖州市中心医院麻醉科,浙江湖州313003

出　　处：《中国卫生检验杂志》2018年第12期1495-1498,共4页Chinese Journal of Health Laboratory Technology

摘　　要：目的分析全麻复合硬膜外麻醉对老年腹部手术后患者细胞因子及安全性。方法选取2014年5月-2015年11月在湖州市中心医院接受腹部手术的老年患者93例,按随机法分为对照组(n=46)和复合组(n=47)。对照组患者给予单纯全麻,复合组患者给予全麻复合硬膜外麻醉。观察并比较不同时间点2组患者血流动力学指标变化,手术前后炎症因子、肾上腺素、血糖水平变化,记录2组患者呼唤睁眼恢复时间、指令反应恢复时间及拔管时间。结果复合组患者在T1、T2、T3时SBP、DBP、MAP及HR水平均低于对照组患者同时间段;复合组患者术后2 h时TNF-α、IL-6、IL-8、AD、NE及血糖水平均低于对照组患者;复合组患者呼唤睁眼恢复时间、指令反应恢复时间及拔管时间均较对照组患者时间长,差异均有统计学意义(P<0.05)。结论全麻复合硬膜外麻醉能有效降低老年腹部手术患者的炎症因子水平和应激反应,且对患者肺功能影响较小,安全性高。Objective To analyze the cytokine and safety of general anesthesia in elderly patients after abdominal operation.Methods 93 elderly patients during May 2014 November-2015 underwent abdominal surgery in Huzhou Central Hospital were randomly divided into control group（n = 46） and combined group（n = 47）. The control group were only given general anesthesia,combined group were treated with general anesthesia combined with epidural anesthesia. To observe and compare the changes in hemodynamic parameters between the two groups at different time points,changes in inflammatory factors,epinephrine and blood glucose levels before and after surgery. The recovery time,command response recovery time,and extubation time were recorded in the both groups. Results The serum levels of SBP,DBP,MAP,and HR in patients of the composite group at T1,T2,and T3 were lower than those in the control group at the same time; the levels of TNF-α,IL-6,IL-8,AD,NE and the blood glucose level in the composite group at 2 h after surgery were lower than that of the control group. The recovery time,command response recovery time,and extubation time were significantly longer in the composite group than that in the control group,and the differences were statistically significant（P〈0. 05）. Conclusion Combined general and epidural anesthesia can effectively reduce the inflammatory factors and stress reaction in elderly patients undergoing abdominal surgery,and have less influence on lung function and safety.

关 键 词：全麻 全麻复合硬膜外麻醉 老年 腹部手术 安全性 

分 类 号：R614[医药卫生—麻醉学]