摘要
目的探讨不同麻醉方式对老年开胸手术患者麻醉苏醒期苏醒质量及应激状态的影响。方法选择2016年10月至2017年8月浙江萧山医院和浙江大学医学院附属杭州市第一人民医院共106例老年开胸手术患者,依据随机数字表法将患者分为研究组和对照组,各53例。研究组给予硬膜外复合全身麻醉,对照组给予静吸复合全身麻醉。比较两组患者的镇静程度和拔管时间,术前和术后6 h的肾上腺素、皮质醇和去甲肾上腺素等应激指标,TNF-α、IL-6和CRP等炎性因子水平以及血液流变学指标。结果研究组患者的镇静程度评分高于对照组,拔管时间短于对照组(均P<0.05)。研究组患者的肾上腺素、皮质醇和去甲肾上腺素等应激指标水平均低于对照组(均P<0.05)。研究组患者的TNF-α、IL-6和CRP炎性因子水平均低于对照组(均P<0.05)。研究组患者的高切黏度和全血低切黏度低于对照组(均P<0.05)。结论硬膜外复合全身麻醉可提高老年开胸手术患者苏醒质量,减轻应激和炎性因子水平,改善血液流变学指标。
Objective To investigate the effect of different anesthesia methods on recovery quality and stress state during anesthesia recovery period in elderly patients undergoing thoracic surgery.Methods A total of 106 elderly patients undergoing Thoracic surgery in Zhejiang Xiaoshan Hospital and Hangzhou First People's Hospital from October 2016 to August 2017 were enrolled.Patients were randomly divided into two groups with 53 cases in each group:patients in the study group were given epidural combined general anesthesia,while those in the control group were given intravenous-inhalation combined anesthesia.The degree of sedation and extubation time,stress indexes such as epinephrine,cortisol and norepinephrine,levels of inflammatory factors such as TNF-α,IL-6 and CRP,and hemorheology indexes were compared between the two groups.Results the sedation score of the study group was higher than that of the control group,the extubation time was significantly shorter than that of the control group(P<0.05).The epinephrine,cortisol and norepinephrine levels in the study group were lower than those in the control group(P<0.05).The level of TNF-α,IL-6 and CRP in the study group were lower than those in the control group(P<0.05).The whole blood high shear viscosity and low shear viscosity of patients in the study group were lower than those in the control group(P<0.05).Conclusion epidural combined general anesthesia can improve the quality of recovery,reduce the level of stress and inflammatory status,and improve hemorheological indexes in elderly patients undergoing thoracic surgery.
作者
宋少波
倪立峰
陶守君
余静
谢芳华
杜强
孙建良
SONG Shaobo;NI Li feng;TAO Shoujun;YU Jing;XIE Fanghua;DU Qiang;SUN Jianliang(Department of Anesthesiology,Hangzhou First People's Hospital,Hangzhou 310006,China)
出处
《浙江医学》
CAS
2020年第16期1746-1749,共4页
Zhejiang Medical Journal
