萬(wàn)小勇++++++涂傳剛++++++鄧勝文

[摘要]目的 探討腰-硬聯(lián)合麻醉對(duì)老年骨科手術(shù)患者應(yīng)激反應(yīng)及血流動(dòng)力學(xué)的影響。方法 選擇2015年2月～2016年2月于我院進(jìn)行手術(shù)治療的100例老年骨折患者作為研究對(duì)象，按照隨機(jī)數(shù)字表法分為觀察組與對(duì)照組，各50例。對(duì)照組予以全身麻醉，觀察組采用腰-硬聯(lián)合麻醉，比較兩組的應(yīng)激反應(yīng)及血流動(dòng)力學(xué)指標(biāo)變化。結(jié)果 觀察組的腎上腺素、血管緊張素、腎素、去甲腎上腺素水平均低于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。兩組麻醉前的DBP、SBP、HR指標(biāo)水平比較，差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。兩組麻醉后10、30 min的DBP、SBP、HR水平較麻醉前均呈現(xiàn)出明顯下降趨勢(shì)，且對(duì)照組下降速度更快，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 老年骨科手術(shù)患者采用腰-硬聯(lián)合麻醉干預(yù)有利于減輕患者的應(yīng)激反應(yīng)，改善血流動(dòng)力學(xué)指標(biāo)，值得臨床廣泛應(yīng)用。

[關(guān)鍵詞]腰-硬聯(lián)合麻醉；老年；骨科手術(shù)；應(yīng)激反應(yīng)；血流動(dòng)力學(xué)

[中圖分類號(hào)] R614.4 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1674-4721（2017）09（c）-0034-03

[Abstract]Objective To investigate the influence of combined spinal-epidural anesthesia （CSEA） on stress response and hemodynamics in senile patients with orthopedic surgery.Methods 100 senile patients with fracture received surgery in our hospital from February 2015 to February 2016 were selected as the research object，and they were divided into the observation group and the control group according to random number table method，50 cases in each group.The patients in control group was given general anesthesia，while the patients in observation group was given CSEA.The stress response and changes of hemodynamic indexes were compared between the two groups.Results The epinephrine，angiotensin，renin，norepinephrine in the observation group was lower than that in the control group，with statistical difference （P<0.05）.Before the anesthesia，the level of DBP，SBP，HR between the two groups were compared，there was no statistical difference （P>0.05）.After the anesthesia for 10 min and 30 min，the levels of DBP，SBP，HR in the two groups significantly decreased compared with those before anesthesia，and the descend speed of the control group was more quicker，with statistical difference （P<0.05）.Conclusion CSEA in senile patients with orthopedic surgery is effective，it can reduce stress response and improve indexes of hemodynamics，which is worthy of clinical application.

[Key words]Combined spinal-epidural anesthesia；Senile；Orthopedic surgery；Stress response；Hemodynamics

老年人群因自身多項(xiàng)功能減退以及骨質(zhì)疏松的進(jìn)漸性加重，骨密度減少，使得老年骨折的發(fā)生率越來(lái)越高[1-2]。據(jù)臨床數(shù)據(jù)顯示，骨科臨床中約有30%以上的患者為老年患者[3]。隨著年齡的增長(zhǎng)，機(jī)體各項(xiàng)器官會(huì)出現(xiàn)明顯退化，基礎(chǔ)疾病多，對(duì)手術(shù)的耐受程度也隨之下降，因此老年患者采用骨科手術(shù)治療所承擔(dān)的風(fēng)險(xiǎn)也更高，術(shù)后并發(fā)癥及預(yù)后不良等情況發(fā)生的概率也隨之升高[4-5]。已有研究顯示，合理有效的麻醉技術(shù)與平穩(wěn)的麻醉狀態(tài)能降低手術(shù)風(fēng)險(xiǎn)，減輕應(yīng)激反應(yīng)發(fā)生，盡可能減少術(shù)后并發(fā)癥的發(fā)生[6-7]。本研究旨在探討腰-硬聯(lián)合麻醉對(duì)老年骨科手術(shù)患者應(yīng)激反應(yīng)及血流動(dòng)力學(xué)的影響，現(xiàn)報(bào)道如下。

1資料與方法

1.1一般資料

選擇2015年2月～2016年2月于我院進(jìn)行手術(shù)治療的100例老年骨折患者作為研究對(duì)象，按照隨機(jī)數(shù)字表法分為觀察組與對(duì)照組，各50例。觀察組中，男32例，女18例；年齡65～87歲，平均（73.46±3.57）歲；體重50～84 kg，平均（68.24±5.46）kg；其中14例全髖關(guān)節(jié)置換術(shù)，26例股骨頭置換術(shù)，10例膝關(guān)節(jié)置換術(shù)。對(duì)照組中，男35例，女15例；年齡64～88歲，平均（74.12±3.96）歲；體重49～85 kg，平均（68.96±5.82）kg；其中15例全髖關(guān)節(jié)置換術(shù)，24例股骨頭置換術(shù)，11例膝關(guān)節(jié)置換術(shù)。兩組的一般資料比較，差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05），具有可比性。endprint