硬膜外复合全身麻醉对老年腹部手术患者血流动力学与认知功能的影响  

Effect of epidural anesthesia combined with general anesthesia on hemodynamics and cognitive function in elderly patients undergoing abdominal surgery

作　　者：郑法启 ZHENG Faqi(Department of Anesthesiology,Anqiu Maternal and Child Health Hospital in Shandong Province,Anqiu 262100,China)

机构地区：[1]山东省安丘市妇幼保健院麻醉科

出　　处：《中国现代医生》2019年第13期104-107,共4页China Modern Doctor

摘　　要：目的探讨硬膜外麻醉复合全身麻醉与全身麻醉对老年腹部手术患者围手术期血流动力学变化与术后认知功能的影响。方法选择2017年3月~2018年6月择期行腹部手术的老年患者180例,按照入院先后顺序,以随机数字表法分为硬膜外麻醉复合全身麻醉(复合组)与全身麻醉组(全麻组)。观察两组患者麻醉前(T1)、麻醉后30min(T2)、拔管前15min(T3)、拔管时(T4)、拔管后1h(T5)患者平均动脉压(MAP)、心率(HR)变化。酶联免疫吸附法检测T1、T4时间点血清白细胞介素-6(IL-6),免疫比浊法检测血清超敏C-反应蛋白(hs-CRP)水平变化。观察两组患者手术前与术后第1天认知功能情况以及围手术期液体负荷量。结果麻醉前,两组患者MAP与HR水平比较,差异无统计学意义(P>0.05)。麻醉后,两组患者麻醉后30min(T2)、拔管前15min(T3)、拔管时(T4)、拔管后1h(T5)患者MAP、HR水平变化显著,但复合组下降幅度<15%,两组比较,差异有统计学意义(P<0.05)。麻醉后,复合组患者血清IL-6、hs-CRP水平明显低于全麻组,组内与组间比较,差异有统计学意义(P<0.05)。术后,复合组患者MMSE评分高于全麻组,谵妄发生率也显著降低,围手术期输液量减少,两组比较,差异有统计学意义(P<0.05)。结论硬膜外麻醉复合全身麻醉可有效抑制围手术期应激炎性反应,保持血流动力学稳定,减少术中液体负荷,降低术后谵妄发生率。Objective To investigate the effect of epidural anesthesia combined with general anesthesia and general anesthesia on perioperative hemodynamic changes and postoperative cognitive function in elderly patients undergoing abdominal surgery.Methods A total of 180 elderly patients undergoing elective abdominal surgery from March 2017 to June 2018 were enrolled.According to the order of admission,they were divided into epidural anesthesia combined with general anesthesia(combined group)and general anesthesia group according to random number table method.The changes of mean arterial pressure(MAP)and heart rate(HR)of the patients in the two groups before the anesthesia(T1),at 30 minutes after anesthesia(T2),at 15 minutes before the extubation(T3),at the time of extubation(T4),and at 1 h after the extubation(T5)were observed.Serum interleukin-6(IL-6)was detected by enzyme-linked immunosorbent assay(ELISA)at the time of T1 and T4,and the level of serum high-sensitivity C-reactive protein(hs-CRP)was detected by immunoturbidimetric assay.The cognitive function and perioperative fluid load before surgery and on the 1st day after surgery were observed.Results Before anesthesia,there was no significant difference in MAP and HR between the two groups(P>0.05).The MAP and HR levels of patients in the two groups were significantly changed 30 minutes after anesthesia(T2),at 15 minutes before extubation(T3),at the time of extubation(T4),and at 1 h after extubation(T5).However,the combined group was decreased by<15%,and the difference between the two groups was statistically significant(P<0.05).After anesthesia,serum IL-6 and hs-CRP levels in the combined group were significantly lower than those in the general anesthesia group.There was significant difference within and between the two groups(P<0.05).After operation,the MMSE score of the combined group was higher than that of the general anesthesia group,and the incidence of sputum in the combined group was also significantly decreased,and the perioperative infusion volume was decre

关 键 词：认知障碍 复合麻醉 全身麻醉 硬膜外麻醉 炎性反应 

分 类 号：R614[医药卫生—麻醉学]