萬小勇++++++涂傳剛++++++鄧勝文
[摘要]目的 探討腰-硬聯合麻醉對老年骨科手術患者應激反應及血流動力學的影響。方法 選擇2015年2月~2016年2月于我院進行手術治療的100例老年骨折患者作為研究對象,按照隨機數字表法分為觀察組與對照組,各50例。對照組予以全身麻醉,觀察組采用腰-硬聯合麻醉,比較兩組的應激反應及血流動力學指標變化。結果 觀察組的腎上腺素、血管緊張素、腎素、去甲腎上腺素水平均低于對照組,差異有統計學意義(P<0.05)。兩組麻醉前的DBP、SBP、HR指標水平比較,差異無統計學意義(P>0.05)。兩組麻醉后10、30 min的DBP、SBP、HR水平較麻醉前均呈現出明顯下降趨勢,且對照組下降速度更快,差異有統計學意義(P<0.05)。結論 老年骨科手術患者采用腰-硬聯合麻醉干預有利于減輕患者的應激反應,改善血流動力學指標,值得臨床廣泛應用。
[關鍵詞]腰-硬聯合麻醉;老年;骨科手術;應激反應;血流動力學
[中圖分類號] R614.4 [文獻標識碼] A [文章編號] 1674-4721(2017)09(c)-0034-03
[Abstract]Objective To investigate the influence of combined spinal-epidural anesthesia (CSEA) on stress response and hemodynamics in senile patients with orthopedic surgery.Methods 100 senile patients with fracture received surgery in our hospital from February 2015 to February 2016 were selected as the research object,and they were divided into the observation group and the control group according to random number table method,50 cases in each group.The patients in control group was given general anesthesia,while the patients in observation group was given CSEA.The stress response and changes of hemodynamic indexes were compared between the two groups.Results The epinephrine,angiotensin,renin,norepinephrine in the observation group was lower than that in the control group,with statistical difference (P<0.05).Before the anesthesia,the level of DBP,SBP,HR between the two groups were compared,there was no statistical difference (P>0.05).After the anesthesia for 10 min and 30 min,the levels of DBP,SBP,HR in the two groups significantly decreased compared with those before anesthesia,and the descend speed of the control group was more quicker,with statistical difference (P<0.05).Conclusion CSEA in senile patients with orthopedic surgery is effective,it can reduce stress response and improve indexes of hemodynamics,which is worthy of clinical application.
[Key words]Combined spinal-epidural anesthesia;Senile;Orthopedic surgery;Stress response;Hemodynamics
老年人群因自身多項功能減退以及骨質疏松的進漸性加重,骨密度減少,使得老年骨折的發生率越來越高[1-2]。據臨床數據顯示,骨科臨床中約有30%以上的患者為老年患者[3]。隨著年齡的增長,機體各項器官會出現明顯退化,基礎疾病多,對手術的耐受程度也隨之下降,因此老年患者采用骨科手術治療所承擔的風險也更高,術后并發癥及預后不良等情況發生的概率也隨之升高[4-5]。已有研究顯示,合理有效的麻醉技術與平穩的麻醉狀態能降低手術風險,減輕應激反應發生,盡可能減少術后并發癥的發生[6-7]。本研究旨在探討腰-硬聯合麻醉對老年骨科手術患者應激反應及血流動力學的影響,現報道如下。
1資料與方法
1.1一般資料
選擇2015年2月~2016年2月于我院進行手術治療的100例老年骨折患者作為研究對象,按照隨機數字表法分為觀察組與對照組,各50例。觀察組中,男32例,女18例;年齡65~87歲,平均(73.46±3.57)歲;體重50~84 kg,平均(68.24±5.46)kg;其中14例全髖關節置換術,26例股骨頭置換術,10例膝關節置換術。對照組中,男35例,女15例;年齡64~88歲,平均(74.12±3.96)歲;體重49~85 kg,平均(68.96±5.82)kg;其中15例全髖關節置換術,24例股骨頭置換術,11例膝關節置換術。兩組的一般資料比較,差異無統計學意義(P>0.05),具有可比性。endprint