| 高峻峰,雷义高,秦小杰,郭有才,王 海.全身麻醉联合硬膜外麻醉在腹腔镜胆囊切除术高血压患者中的应用效果观察[J].,2020,(7):1355-1359 |
| 全身麻醉联合硬膜外麻醉在腹腔镜胆囊切除术高血压患者中的应用效果观察 |
| Application Effect of General Anesthesia Combined with Epidural Anesthesia on Hypertension Patients Undergoing Laparoscopic Cholecystectomy |
| 投稿时间：2019-07-29 修订日期：2019-08-23 |
| DOI：10.13241/j.cnki.pmb.2020.07.034 |
| 中文关键词: 全身麻醉 硬膜外麻醉 腹腔镜胆囊切除术 高血压 麻醉效果 |
| 英文关键词: General anesthesia Epidural anesthesia Laparoscopic cholecystectomy Hypertension anesthesia effect |
| 基金项目:内蒙古自治区科技计划项目（20161605） |
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| 中文摘要: |
| 摘要 目的：探讨全身麻醉联合硬膜外麻醉对腹腔镜胆囊切除术（LC）高血压患者麻醉效果、血流动力学和T细胞亚群的影响。方法：选取2017年3月~2019年3月期间我院收治的113例行LC的高血压患者，采用随机数字表法分为对照组（n=56）和研究组（n=57），对照组患者予以全身麻醉，研究组在对照组的基础上联合硬膜外麻醉，比较两组患者麻醉效果、血流动力学[心率（HR）、平均动脉压（MAP）]、T细胞亚群、术后恢复情况及并发症。结果：研究组的麻醉效果优良率为91.23%（52/57），高于对照组的76.79%（43/56）（P<0.05）。研究组麻醉诱导前（T1）、插管后2 min（T2）、气腹后10 min（T3）、术中探查（T4）、术毕气管导管拔出2 min后（T5）时间点HR、MAP无明显变化，对照组T1~T5 时间点HR、MAP呈现先下降后升高趋势（P<0.05）；研究组T1、T2时间点HR高于对照组，T4和T5时间点HR则低于对照组（P<0.05）；研究组各时间点MAP均低于对照组（P<0.05）。两组术毕1d（T6）、术毕3d（T7）时间CD4+、CD4+/ CD8+均较T1较低，CD8+较T1升高，但研究组CD4+、CD4+/ CD8+高于对照组，CD8+则低于对照组（P<0.05）。研究组术后睁眼时间、定向力恢复时间、拔管时间均短于对照组（P<0.05）。两组并发症发生率比较无差异（P>0.05）。结论：高血压患者行LC时给予全身麻醉联合硬膜外麻醉，麻醉效果显著，可有效稳定机体血流动力学，减轻免疫抑制，促进患者术后意识恢复，且不增加并发症发生率。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the effect of general anesthesia combined with epidural anesthesia on anesthesia, hemodynamics and T cell subsets in patients with hypertension undergoing laparoscopic cholecystectomy (LC). Methods: 113 patients with hypertension treated by LC in our hospital from March 2017 to March 2019 were selected, they were randomly divided into two groups: control group(n=56) and study group(n=57). The control group was given general anesthesia. The study group was combined with epidural anesthesia on the basis of the control group to compare the anesthesia effect, hemodynamics [heart rate(HR), mean arterial pressure (map)] T cell subsets, postoperative recovery and complications. Results: The excellent rate of anesthesia effect in the study group was 91.23% (52/57), which was higher than 76.79% (43/56) in the control group(P<0.05). HR and map at time points before anesthesia induction (T1), 2 minutes after intubation (T2), 10 minutes after pneumoperitoneum (T3), intraoperative exploration (T4), and 2 minutes after tracheal catheter extraction (T5) in the study group showed no significant change, while HR and map at time points t1-t5 in the control group showed a trend of first decreasing and then increasing(P<0.05); HR at time points T1 and T2 in the study group was higher than that in the control group, while HR at time points T4 and T5 in the study group was lower than that in the control group(P<0.05)）The map of each time point in the study group was lower than that in the control group(P<0.05). CD4+, CD4+/CD8+ were lower and CD8+ were higher in the study group than in the control group, but CD4+, CD4+/CD8+ were higher in the study group than in the control group, and CD8+ were lower in the study group than in the control group(P<0.05). The time of eye opening, directional force recovery and extubation in the study group were shorter than those in the control group(P<0.05). There was no difference in the incidence of complications between the two groups(P>0.05). Conclusion: General anesthesia combined with epidural anesthesia can effectively stabilize the hemodynamics, reduce the immunosuppression, promote the recovery of consciousness, and do not increase the incidence of complications. |
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