全身麻醉与硬膜外复合全身麻醉对老年腹腔镜胆囊切除术患者麻醉效果及应激反应的影响  

Effect of general anesthesia and epidural anesthesia combined with general anesthesia on anesthesia effect and stress response in elderly patients undergoing laparoscopic cholecystectomy

作　　者：王永丽 蔡丽娟 WANG Yongli;CAI Lijuan(Department of Anesthesiology,Baoji Jintai Hospital,Baoji,Shaanxi 721001,China)

机构地区：[1]宝鸡市金台医院麻醉科,陕西宝鸡721001

出　　处：《检验医学与临床》2022年第12期1660-1663,共4页Laboratory Medicine and Clinic

摘　　要：目的探讨全身麻醉与硬膜外复合全身麻醉对老年腹腔镜胆囊切除术患者麻醉效果及应激反应的影响。方法选取2019年2月至2021年2月该院麻醉科老年腹腔镜下胆囊切除术患者120例,依据麻醉方法分为硬膜外麻醉复合全身麻醉组(EG组)、全身麻醉组(G组)两组,各60例,统计分析两组患者的麻醉前(T1)、气管插管后5 min(T2)、气腹后5 min(T3)、完成手术前5 min(T4)、完成手术拔管后5 min(T5)血流动力学、围术期应激反应、围术期相关指标、镇痛和镇静效果、术后疼痛、躁动情况。结果T1、T2、T3、T4、T5时两组患者的心率、舒张压、收缩压、平均动脉压之间的差异无统计学意义(P>0.05)。二氧化碳气腹后40 min,EG组患者的血糖、皮质醇水平均低于G组(P<0.05)。EG组患者的拔管时间、睁眼时间、清醒时间均短于G组(P<0.05)。EG组患者术后2、6、12 h的VAS静态评分、VAS动态评分均低于G组(P<0.05),Ramsay评分均高于G组(P<0.05)。EG组患者的术后轻微疼痛发生率高于G组(P<0.05),中度疼痛、重度疼痛、躁动发生率均低于G组(P<0.05)。结论硬膜外复合全身麻醉对老年腹腔镜下胆囊切除术患者围术期应激反应的影响较全身麻醉更小。Objective To investigate the effect of general anesthesia and epidural combined general anesthesia on anesthesia effect and stress response in elderly patients undergoing laparoscopic cholecystectomy.Methods A total of 120 cases of elderly patients with laparoscopic cholecystectomy in anesthesia department of the hospital from February 2019 to February 2021 were selected.According to the anesthesia methods,120 cases of patients were divided into epidural anesthesia combined general anesthesia group(EG group)and general anesthesia group(G group),60 cases in each group,respectively.The hemodynamics before anesthesia(T1),5 min after endotracheal intubation(T2),5 min after pneumoperitoneum(T3),5 min before the operation completed(T4),5 min after extubation(T5),perioperative stress response,perioperative related indexes,analgesic and sedative effects,incidences of postoperative pain,restlessness of the two groups were statistically analyzed.Results There was no significant difference in heart rate,diastolic blood pressure,systolic blood pressure and mean arterial pressure between the two groups at T1,T2,T3,T4 and T5(P>0.05).At 40 min after carbon dioxide pneumoperitoneum,the blood glucose and cortisol levels of the patients in EG group were lower than those in G group(P<0.05).The time of pulling out the tube,opening eyes and waking time in EG group were shorter than those in G group(P<0.05).The static score and dynamic score of VAS were lower in EG group at 2,6 and 12 h after operation than those in G group(P<0.05),and the Ramsay score was higher than that in G group(P<0.05).The incidence of mild pain in EG group was higher than that in G group(P<0.05),and the incidence of moderate pain,severe pain and restlessness were lower than those in G group(P<0.05).Conclusion The effect of epidural anesthesia combined with general anesthesia on perioperative stress response of elderly patients with laparoscopic cholecystectomy is less than that of general anesthesia.

关 键 词：全身麻醉 硬膜外麻醉 胆囊切除术 腹腔镜 老年人 

分 类 号：R641[医药卫生—外科学]