| 朱利娟,徐 钊,付华君,高 娜,张玉明.全身麻醉复合硬膜外麻醉与全身麻醉对老年腹部肿瘤手术患者的影响[J].,2020,(4):714-717 |
| 全身麻醉复合硬膜外麻醉与全身麻醉对老年腹部肿瘤手术患者的影响 |
| Effect of General Anesthesia Combined with Epidural Anesthesia and General Anesthesia on the Elderly Patients with Abdominal Tumor |
| 投稿时间：2019-05-06 修订日期：2019-05-30 |
| DOI：10.13241/j.cnki.pmb.2020.04.024 |
| 中文关键词: 全身麻醉 硬膜外麻醉 腹部肿瘤 应激激素 |
| 英文关键词: General Anesthesia Epidural Anesthesia Abdominal Tumor Stress Hormone |
| 基金项目:陕西省自然科学基金面上项目(2018JM7047035) |
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| 中文摘要: |
| 摘要 目的：探究全身麻醉复合硬膜外麻醉与全身麻醉对老年腹部肿瘤手术患者影响。方法：选择2015年10月-2018年10月于我院进行手术治疗的老年腹部肿瘤患者96例，随机分为两组，每组48例患者。其中，对照组患者给予全身麻醉，研究组患者联合硬膜外麻醉，对比两组患者的麻醉指标、围术期指标、应激激素指标、肺功能指标和不同时间点血清NSE、S100β浓度的变化。结果：研究组患者的瑞芬太尼用量、异丙酚用量、苏醒时间、拔管时间均显著少于(短于)对照组(P＜0.05)；对照组患者术后肾上腺素、去甲肾上腺素、皮质醇等指标水平均比术前显著升高(P＜0.05)；研究组患者术后的去甲肾上腺素水平显著高于术前(P＜0.05)，但肾上腺素、皮质醇与术前无显著性差异(P＜0.05)；随着治疗时间推移，两组患者手术1 h时、手术时2 h时、术毕时血清NSE、S100β浓度呈逐渐升高趋势，且研究组患者以上指标均明显低于对照组(P＜0.05)；对照组患者术后的(MVV-VE)/FEV1、MVV/FEV1指标水平均比术前显著降低(P＜0.05)；RV/TLC水平比术前显著升高(P＜0.05)；但研究组患者术后的(MVV-VE)/FEV1、MVV/FEV1、RV/TLC等指标与术前无显著差异(P＞0.05)。结论：与全身麻醉相比，全身麻醉复合硬膜外麻醉可更有效改善老年腹部肿瘤患者手术指标，并控制机体应激反应和降低麻醉过程对脑部的损伤，且对其肺功能影响较小。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the effects of general anesthesia combined with epidural anesthesia and general anesthesia on the elderly patients with abdominal tumors. Methods: Ninety-six elderly patients with abdominal tumors who underwent surgery from October 2015 to October 1818 were randomly divided into two groups, 48 patients in each group.Among them, patients in the control group were given general anesthesia, and patients in the study group were combined with epidural anesthesia. The anesthesia index, perioperative index, stress hormone index, lung function index and serum NSE and S100β concentration at different time points were compared between the two groups. Results: The doses of remifentanil, propofol, wake-up time and extubation time in the study group were significantly less than(shorter than) control group(P<0.05). In the control group, the levels of postoperative adrenaline, norepinephrine and cortisol were significantly higher than those before surgery(P<0.05). With the treatment time, the serum NSE and S100β concentrations in the two groups were gradually increased at 1 h after surgery, 2 h after surgery, and at the end of surgery, but the patients in the study group were lower than the control group(P<0.05). The levels of (MVV-VE)/FEV1 and MVV/FEV1 in the control group were significantly lower than those before surgery(P<0.05). The RV/TLC level was significantly higher than that before surgery(P<0.05). However, there were no significant differences between the study group(MVV-VE)/FEV1, MVV/FEV1, RV/TLC and preoperative(P>0.05); Conclusion: Compared with general anesthesia, general anesthesia combined with epidural anesthesia can more effectively improve the surgical parameters of elderly patients with abdominal tumors, and control the body's stress response and reduce brain injury during anesthesia and have little effect on the lung function. |
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