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外周神经阻滞与腰-硬联合麻醉对老年高血压患者下肢手术应激反应的影响
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| 篇名： | 外周神经阻滞与腰-硬联合麻醉对老年高血压患者下肢手术应激反应的影响 |
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| 摘要： | 目的：探讨外周神经阻滞与腰-硬联合麻醉对老年高血压患者下肢手术患者应激反应的影响。方法：96例拟行单侧下肢手术合并高血压的老年患者，按随机数字表法分为试验组和对照组，各48例。试验组患者采用盐酸罗哌卡因注射液15～25 ml外周神经阻滞麻醉，对照组组采用盐酸布比卡因注射液1.2～1.8 ml腰-硬联合麻醉。观察两组患者的手术时间、麻醉起效时间、阻滞完善时间及术前（T0）、切皮时（T1）、术中（T2）、术毕拔管（T3）时的心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）、肾上腺素（E）、去甲肾上腺素（NE）、血清白细胞介素（IL）6、血清皮质醇（COR）的变化情况。结果：对照组患者的麻醉起效时间、阻滞完善时间均显著低于试验组，差异有统计学意义（P＜0.05）。两组患者的T0、T1、T2、T3时的HR、SpO2比较，差异无统计学意义（P＞0.05）；对照组患者T1、T2、T3时的MAP均显著低于试验组，差异有统计学意义（P＜0.05）。两组患者T0时E、NE、IL-6、COR水平比较，差异无统计学意义（P＞0.05）；对照组患者T1、T2、T3时的E、NE、IL-6、COR水平均高于试验组（P＜0.05）。结论：与硬-腰联合麻醉相比，外周神经阻滞麻醉对拟行单侧下肢手术合并高血压的老年患者麻醉效果较好，循环波动影响小、应激反应轻。 |
| ABSTRACT： | OBJECTIVE： To investigate the effect of combined spinal epidural anesthesia and peripheral nerve block on stress response of patients with hypertension in lower limb surgery. METHODS： 96 patients underwent selective unilateral lower limb surgery were randomly dived into trial group and control group with 48 cases in each group. the trial group was given Ropivacaine hydrochloride injection 15-25 ml for peripheral nerve block， and the trial group was given Bupivacaine hydrochloride injection 1.2-1.8 ml for combined spinal epidural anesthesia. The operation time， the onset time of anesthesia and the time of block improvement were observed in 2 groups， and HR， MAP， SpO2， E， NE， IL-6 and COR were also observed before operation （T0）， at the moment of incision （T1）， during operation （T2） and at the moment of extubation after surgery （T3）. RESULTS： The onset time of anesthesia and the time of block improvement in control group were significantly lower than in trial group， with statistical significance （P＜0.05）. There was no statistical significance in HR and SpO2 between 2 groups at T0， T1， T2 and T3 （P＞0.05）； MAP of control group was significantly lower than that of trial group at T1 and T2， T3， with statistical significance （P＜0.05）. There was no statistical significance in E， NE， IL-6 and COR of 2 groups at T0 （P＞0.05）； E， NE， IL-6 and COR of trial group were significantly higher than those of control group at T1， T2 and T3 （P＜0.05）. CONCLUSIONS： The effect of combined spinal epidural anesthesia is weaker than peripheral nerve block on the circulation fluctuation and stress response of patients with hypertension in lower limb surgery， showing good anesthesia effect. |
| 期刊： | 2016年第27卷第2期 |
| 作者： | 王敏，谢林碧，黄伟文，彭丹丹，黄晓媚 |
| AUTHORS： | WANG Min，XIE Linbi，HUANG Weiwen，PENG Dandan，HUANG Xiaomei |
| 关键字： | 腰-硬联合麻醉；外周神经阻滞；高血压；下肢手术；应激反应 |
| KEYWORDS： | Combined spinal epidural anesthesia； Peripheral nerve block； Hypertension； Lower limb surgery； Stress reaction |
| 阅读数： | 192 次 |
| 本月下载数： | 2 次 |
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