硬膜外复合全身麻醉对老年开胸手术患者应激和血液流变学的影响

目的:探讨硬膜外复合全身麻醉对老年开胸手术患者应激和血液流变学的影响。方法:选取了100例开胸手术患者,按手术顺序编号将患者随机分为两组,对照组(46例)开胸手术术前给予全身麻醉,观察组(54例)开胸手术前给予硬膜外复合全身麻醉。通过观察并记录术前、术后1 h、6 h的应激指标、血液流变学指标及心率、呼吸频率,评价硬膜外复合全身麻醉对老年开胸手术患者应激和血液流变学的影响。结果:术前两组血糖、皮质醇和肾上腺素水平相比,无统计学差异(P0.05)。术后1 h,6 h两组血糖、皮质醇和肾上腺素水平均升高(P0.05),观察组术后1 h,6 h血糖、皮质醇和肾上腺素水平均低于对照组(P0.05);术后1 h,6 h两组全血低切粘度、高切粘度均下降,且观察组全血低切粘度、高切粘度更低(P0.05),术前术后两组血浆粘度、红细胞聚集指数相比,无统计学差异(P0.05);对照组患者术后1 h心率增加且高于观察组(P0.05),术后6 h心率趋近于术前心率。观察组患者术前术后心率无统计学差异(P0.05)。对照组患者术后1 h、6 h呼吸频率增加且高于观察组(P0.05),观察组患者术前术后呼吸频率无统计学差异(P0.05)。结论:采用硬膜外复合全麻对老年开胸手术患者的生命体征影响较小,可降低术后应激反应,改善患者体内血液流变学参数,值得临床推广使用。

Effect of Epidural Anesthesia Combined with General Anesthesia on Stress and Blood Rheology in Elderly Patients with Open Thoracic Surgery

ABSTRACT Objective: To discuss the effect of epidural anesthesia combined with general anesthesia on stress and blood rheology in elderly patients with open thoracic surgery. Methods: 100 elderly patients with open thoracic surgery were selected and divided randomly into two groups according to the sequence of operation. The control group (46 cases) was given general anesthesia before surgery. The observation group (54 cases) was given epidural anesthesia combined with general anesthesia before surgery. The effect of epidural anesthesia combined with general anesthesia on the stress and blood rheology was evaluated by the stress indexes, blood rheology indexes, heart rate and respiratory rate before surgery, after 1 h, 6 h surgery. Results: There were no statistical significance on blood glucose, cortisol and epinephrine levels between two groups(P>0.05). At 1 h, 6 h after surgery, the blood glucose, cortisol and epinephrine levels were increased in two groups(P<0.05), and these indexes of observation group was lower than those of the control group(P<0.05). At 1h, 6h after surgery, the whole blood low shear viscosity and high shear viscosity were decreased(P<0.05), and these indexes of observation group was lower than those of the control group(P<0.05). But there were no statistical significance on the plasma viscosity and erythrocyte aggregation indexes between two groups(P>0.05). At 1 h after surgery, the heart rate of observation group was higher than that of the observation group(P<0.05), and the heart rate of 6 h after surgery was close to the preoperative heart rate. In the observation group, there were no statistical significance on heart rate before and after surgery(P>0.05). After 1 h and 6 h of surgery, the respiratory rate of the control group was higher than that of the observation group(P<0.05). In the observation group, there were no statistical significance on respiratory rate before and after surgery(P<0.05). Conclusion: The epidural anesthesia combined with general anesthesia has little effect on the vital signs of elderly patients with open thoracic surgery, and it can reduce the stress reaction and improve blood rheology parameters of patients, worthy of clinical application.