摘要
目的对比硬膜外麻醉复合全身麻醉与单纯全身麻醉对老年腹部手术患者心肌损伤的影响。方法选取崇州市人民医院2014年1月—2015年12月行腹部手术的老年患者92例,根据患者麻醉方式的不同,将其分成观察组和对照组,每组46例。对照组采用单纯全身麻醉,观察组采用硬膜外麻醉复合全身麻醉。记录并比较2组患者在不同时间点的凝血纤溶指标、心肌功能指标变化情况、麻醉效果、麻醉清醒时间以及苏醒期躁动发生率。结果观察组患者手术后6、12 h时凝血活酶时间(activated partial thromboplastin time,APTT)水平与手术麻醉前比较差异有统计学意义(P<0.05);对照组患者术后6、12 h APTT、凝血酶原时间(prothrombin time,PT)、凝血酶时间(thrombin time,TT)、纤维蛋白原(fibrinogen,FIB)、血小板(platelet,PLT)水平较手术麻醉前存在明显变化(P<0.05),其中对照组术后12 h FIB水平明显高于观察组(P<0.05);2组患者术后6、12 h肌酸肌酶同工酶(creatine kinase-MB,CK-MB)及心肌肌钙蛋白(cardial troponin Ⅰ,cTnⅠ)指标水平较手术麻醉前有明显变化(P<0.05);对照组患者在术后6、12 h CK-MB及cTnⅠ指标变化水平与观察组有明显差异(P<0.05);2组患者在切皮及术中30 min时,心率(HR)水平均较治疗前有明显变化(P<0.05),观察组患者在切皮及术中30 min时HR、平均动脉压(mear arterial pressure,MAP)水平明显低于对照组(P<0.05)。对照组麻醉清醒时间、苏醒期躁动发生率明显高于观察组(P<0.05)。结论硬膜外麻醉复合全身麻醉与单纯全身麻醉比较,前者更能降低对老年腹部手术患者凝血纤溶系统及心肌功能的影响,术中循环稳定,术后患者清醒时间短,值得临床运用推广。
Objective To compare the effect of epidural anesthesia combined with general anesthesia with that of general anesthesia on myocardial injury in elderly patients undergoing abdominal surgery. Methods Ninety-two cases of elderly patients who had received abdominal surgery in our hospital between January 2014 and December 2015 were equally divided into observation group and control group according to the methods of anesthesia. Patients in the control group were treated with general anesthesia, while the observation group was treated with epidural anesthesia combined with general anesthesia. Coagulation and fibrinolysis indicators, changes in myocardial function indicators, anesthetic effect, post-anesthetic awake time and the incidence of recovery restlessness were recorded at different time points and compared between the two groups of patients. Results APTT levels of patients in the observation group changed significantly 6 h and 12 h after surgery （P〈0.05）, so did APTT, PT, TT, FIB, and PLT levels in the c6ntrol group （P〈0.05）. The level of FIB was significantly higher than in the observation group 12 h after surgery （P〈0.05）. There were significant changes in the levels of CK-MB and cTnI in both groups 6 h and 12 h after surgery （P〈0.05）. There was significant difference in the levels of CK-MB and cTnI between the two groups 6 h and 12 h after surgery （P〈0.05）. Both groups in 30 min into the skin incision surgery were significantly changed compared with before treatment. HR and MAP levels in the observation group were significantly lower than those of the control group 30 min into the skin incision surgery （P〈0.05）. The incidence of restlessness was significantly higher and post-anesthetic awake time was significantly shorter in the control group than inthe observation group （P〈0.05）. Conclusion Epidural anesthesia combined with general anesthesia can reduce the effect on the fibrinolytic system and myocardial function in elderly recipients of abdominal surgery. Perioperataive circulation is stable, postoperative awake time is short, so this approach is worthy of popularization.
出处
《空军医学杂志》
2017年第5期315-318,共4页
Medical Journal of Air Force
基金
四川省卫生厅科研课题资助项目(120206)
关键词
硬膜外麻醉
单纯全身麻醉
老年腹部手术
epidural anesthesia
general anesthesia
elderly abdominal surgery
