硬膜外复合全身麻醉对老年腹部手术患者血流动力学与认知功能的影响
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摘要
目的探讨硬膜外麻醉复合全身麻醉与全身麻醉对老年腹部手术患者围手术期血流动力学变化与术后认知功能的影响。方法选择2017年3月～2018年6月择期行腹部手术的老年患者180例,按照入院先后顺序,以随机数字表法分为硬膜外麻醉复合全身麻醉(复合组)与全身麻醉组(全麻组)。观察两组患者麻醉前(T1)、麻醉后30 min(T2)、拔管前15 min(T3)、拔管时(T4)、拔管后1 h(T5)患者平均动脉压(MAP)、心率(HR)变化。酶联免疫吸附法检测T1、T4时间点血清白细胞介素-6(IL-6),免疫比浊法检测血清超敏C-反应蛋白(hs-CRP)水平变化。观察两组患者手术前与术后第1天认知功能情况以及围手术期液体负荷量。结果麻醉前,两组患者MAP与HR水平比较,差异无统计学意义(P>0.05)。麻醉后,两组患者麻醉后30 min(T2)、拔管前15 min(T3)、拔管时(T4)、拔管后1 h(T5)患者MAP、HR水平变化显著,但复合组下降幅度<15%,两组比较,差异有统计学意义(P<0.05)。麻醉后,复合组患者血清IL-6、hs-CRP水平明显低于全麻组,组内与组间比较,差异有统计学意义(P<0.05)。术后,复合组患者MMSE评分高于全麻组,谵妄发生率也显著降低,围手术期输液量减少,两组比较,差异有统计学意义(P<0.05)。结论硬膜外麻醉复合全身麻醉可有效抑制围手术期应激炎性反应,保持血流动力学稳定,减少术中液体负荷,降低术后谵妄发生率。
Objective To investigate the effect of epidural anesthesia combined with general anesthesia and general anesthesia on perioperative hemodynamic changes and postoperative cognitive function in elderly patients undergoing abdominal surgery. Methods A total of 180 elderly patients undergoing elective abdominal surgery from March 2017 to June 2018 were enrolled. According to the order of admission, they were divided into epidural anesthesia combined with general anesthesia(combined group) and general anesthesia group according to random number table method. The changes of mean arterial pressure(MAP) and heart rate(HR) of the patients in the two groups before the anesthesia(T1),at 30 minutes after anesthesia(T2), at 15 minutes before the extubation(T3), at the time of extubation(T4), and at 1 h after the extubation(T5) were observed. Serum interleukin-6(IL-6) was detected by enzyme-linked immunosorbent assay(ELISA) at the time of T1 and T4, and the level of serum high-sensitivity C-reactive protein(hs-CRP) was detected by immunoturbidimetric assay. The cognitive function and perioperative fluid load before surgery and on the 1 st day after surgery were observed. Results Before anesthesia, there was no significant difference in MAP and HR between the two groups(P>0.05). The MAP and HR levels of patients in the two groups were significantly changed 30 minutes after anesthesia(T2), at 15 minutes before extubation(T3), at the time of extubation(T4), and at 1 h after extubation(T5).However, the combined group was decreased by <15%, and the difference between the two groups was statistically significant(P<0.05). After anesthesia, serum IL-6 and hs-CRP levels in the combined group were significantly lower than those in the general anesthesia group. There was significant difference within and between the two groups(P<0.05). After operation, the MMSE score of the combined group was higher than that of the general anesthesia group, and the incidence of sputum in the combined group was also significantly decreased, and the perioperative infusion volume was decreased. The difference between the two groups was statistically significant(P<0.05). Conclusion Epidural anesthesia combined with general anesthesia can effectively inhibit perioperative stress inflammatory response, maintain hemodynamic stability, reduce intraoperative fluid load, and reduce the incidence of postoperative delirium.
Objective To investigate the effect of epidural anesthesia combined with general anesthesia and general anesthesia on perioperative hemodynamic changes and postoperative cognitive function in elderly patients undergoing abdominal surgery. Methods A total of 180 elderly patients undergoing elective abdominal surgery from March 2017 to June 2018 were enrolled. According to the order of admission, they were divided into epidural anesthesia combined with general anesthesia(combined group) and general anesthesia group according to random number table method. The changes of mean arterial pressure(MAP) and heart rate(HR) of the patients in the two groups before the anesthesia(T1),at 30 minutes after anesthesia(T2), at 15 minutes before the extubation(T3), at the time of extubation(T4), and at 1 h after the extubation(T5) were observed. Serum interleukin-6(IL-6) was detected by enzyme-linked immunosorbent assay(ELISA) at the time of T1 and T4, and the level of serum high-sensitivity C-reactive protein(hs-CRP) was detected by immunoturbidimetric assay. The cognitive function and perioperative fluid load before surgery and on the 1 st day after surgery were observed. Results Before anesthesia, there was no significant difference in MAP and HR between the two groups(P>0.05). The MAP and HR levels of patients in the two groups were significantly changed 30 minutes after anesthesia(T2), at 15 minutes before extubation(T3), at the time of extubation(T4), and at 1 h after extubation(T5).However, the combined group was decreased by <15%, and the difference between the two groups was statistically significant(P<0.05). After anesthesia, serum IL-6 and hs-CRP levels in the combined group were significantly lower than those in the general anesthesia group. There was significant difference within and between the two groups(P<0.05). After operation, the MMSE score of the combined group was higher than that of the general anesthesia group, and the incidence of sputum in the combined group was also significantly decreased, and the perioperative infusion volume was decreased. The difference between the two groups was statistically significant(P<0.05). Conclusion Epidural anesthesia combined with general anesthesia can effectively inhibit perioperative stress inflammatory response, maintain hemodynamic stability, reduce intraoperative fluid load, and reduce the incidence of postoperative delirium.
引文
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[10]池智刚,钟林箐,黄君安,等.不同麻醉方式对老年骨科患者术后短期认知功能的影响[J].江西医药,2018,53(11):1298-1299.
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[12]Sahin T,Begec Z,Toprak H,et al.The effects of dexmedetomidine on liver ischemia-reperfusion injury in rates[J].J Surg Res,2013,183(1):385-390.
[13]李晶,余灵祥,董刚.肿瘤患者手术的麻醉临床应用研究进展[J].国际麻醉学与复苏杂志,2015,36(12):1123-1126.
[14]李建芬.不同麻醉方式对肺癌根治术患者血流动力学的影响[J].实用癌症杂志,2017,32(8):1288-1290.
[15]郭权,赵红英.老年术后认知障碍的分析[J].中国临床康复,2013,7(4):643.
[2]王晖,杨春艳,宋宇龙,等.不同麻醉方式对直肠癌患者免疫功能的影响[J].中国现代医药杂志,2018,28(24):71-76.
[3]Dahamni S,Rouelle D,Gressens P,et al.Characterization of the postconditioniing effect of dexmedetonidine in mouse organotypic hippocampal slice cultures subjected to oxygen glucose deprivation[J].Anesthesiology,2010,112(2):373-383.
[4]刘冰冰,蔡立松,王蕊,等.不同麻醉药物对中老年患者麻醉效果及术后认知功能障碍的影响[J].医学临床研究,2018,35(3):422-424.
[5]刘欢,顾小萍.术中认知功能障碍的研究进展[J].安徽医药,2018,22(11):2074-2076.
[6]周美兰.全身麻醉和腰硬联合麻醉对老年骨科患者术后短期认知功能的影响[J].实用临床医药杂志,2018,22(1):91-93.
[7]王敏华,徐桂菊,肖金辉.不同麻醉策略对下肢骨折患者术后镇痛、炎性反应及血管内皮功能的影响[J].河北医药,2018,40(18):2739-2742.
[8]张杰,解雅英,辛学东.不同麻醉方式对老年全髋关节置换术的影响[J].医学综述,2018,24(3):576-580.
[9]刘波,刘江锋,郝恒瑞,等.全身麻醉与椎管内麻醉下肢骨折术后患者认知障碍发生率Meta的分析[J].中国医药导报,2018,15(11):112-115.
[10]池智刚,钟林箐,黄君安,等.不同麻醉方式对老年骨科患者术后短期认知功能的影响[J].江西医药,2018,53(11):1298-1299.
[11]刘洋,高东艳.右美托咪定在老年骨科患者麻醉中的应用进展[J].中国现代医生,2018,56(15):164-167.
[12]Sahin T,Begec Z,Toprak H,et al.The effects of dexmedetomidine on liver ischemia-reperfusion injury in rates[J].J Surg Res,2013,183(1):385-390.
[13]李晶,余灵祥,董刚.肿瘤患者手术的麻醉临床应用研究进展[J].国际麻醉学与复苏杂志,2015,36(12):1123-1126.
[14]李建芬.不同麻醉方式对肺癌根治术患者血流动力学的影响[J].实用癌症杂志,2017,32(8):1288-1290.
[15]郭权,赵红英.老年术后认知障碍的分析[J].中国临床康复,2013,7(4):643.