骨科麻醉：腰—硬联合麻醉对晚年骨科手术患者应激反响及血流动力学的影响

万小勇++++++涂传刚++++++邓胜文

[摘要]意图 讨论腰-硬联合麻醉对晚年骨科手术患者应激反响及血流动力学的影响。办法 挑选2015年2月～2016年2月于我院进行手术医治的100例晚年骨折患者作为研讨目标，依照随机数字表法分为调查组与对照组，各50例。对照组予以全身麻醉，调查组选用腰-硬联合麻醉，比较两組的应激反响及血流动力学目标改变。成果 调查组的肾上腺素、血管严重素、肾素、去甲肾上腺素水均匀低于对照组，差异有统计学含义（P<0.05）。两组麻醉前的DBP、SBP、HR目标水平比较，差异无统计学含义（P>0.05）。两组麻醉后10、30 min的DBP、SBP、HR水平较麻醉前均呈现出显着下降趋势，且对照组下降速度更快，差异有统计学含义（P<0.05）。定论 晚年骨科手术患者选用腰-硬联合麻醉干涉有利于减轻患者的应激反响，改进血流动力学目标，值得临床广泛应用。

[关键词]腰-硬联合麻醉；晚年；骨科手术；应激反响；血流动力学

[中图分类号] R614.4 [文献标识码] A [文章编号] 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

晚年人群因本身多项功用减退以及骨质疏松的进渐性加剧，骨密度削减，使得晚年骨折的发作率越来越高[1-2]。据临床数据显现，骨科临床中约有30%以上的患者为晚年患者[3]。跟着年纪的增加，机体各项器官会呈现显着退化，根底疾病多，对手术的耐受程度也随之下降，因而晚年患者选用骨科手术医治所承当的危险也更高，术后并发症及预后不良等状况发作的概率也随之升高[4-5]。已有研讨显现，合理有用的麻醉技能与平稳的麻醉状况能降低手术危险，减轻应激反响发作，尽可能削减术后并发症的发作[6-7]。本研讨旨在讨论腰-硬联合麻醉对晚年骨科手术患者应激反响及血流动力学的影响，现报导如下。

1材料与办法

1.1一般材料

挑选2015年2月～2016年2月于我院进行手术医治的100例晚年骨折患者作为研讨目标，依照随机数字表法分为调查组与对照组，各50例。调查组中，男32例，女18例；年纪65～87岁，均匀（73.46±3.57）岁；体重50～84 kg，均匀（68.24±5.46）kg；其间14例全髋关节置换术，26例股骨头置换术，10例膝关节置换术。对照组中，男35例，女15例；年纪64～88岁，均匀（74.12±3.96）岁；体重49～85 kg，均匀（68.96±5.82）kg；其间15例全髋关节置换术，24例股骨头置换术，11例膝关节置换术。两组的一般材料比较，差异无统计学含义（P>0.05），具有可比性。endprint