不同浓度利多卡因硬膜外联合全身麻醉对老年开胸病人应激反应的影响

目的探讨5 g/L或10 g/L利多卡因硬膜外联合全身麻醉（全麻）对老年开胸手术病人血压、心率、血液皮质醇和血管紧张素Ⅱ水平的影响。方法ASAⅠ-Ⅱ级、年龄60-78岁拟行肺叶切除术的病人40例,随机分为5 g/L利多卡因组（A组）和10 g/L利多卡因组（B组）,每组20例。麻醉过程中每5 min测量血压、心率1次至手术结束。于麻醉前、切皮后5 min、切皮后30 min、术后1 d分别抽静脉血5 mL测定皮质醇、血管紧张素Ⅱ浓度。结果两组病人切皮后5 min、切皮后30 min及术毕收缩压明显低于麻醉前（t=2.482-11.261,P〈0.05）,B组在切皮后30 min和术毕收缩压明显低于A组（t=2.269、6.066,P〈0.05）,B组切皮后5 min、30 min心率均明显低于麻醉前（t=2.290、2.635,P〈0.05）;两组切皮后30 min血管紧张素Ⅱ水平明显高于麻醉前（t=3.561、4.030,P〈0.05）;两组切皮后30 min和术后1 d皮质醇水平明显高于麻醉前（t=2.171-4.849,P〈0.05、0.01）,两组间无显著性差异（P〉0.05）。B组中有5例病人须用升压药物维持血压。结论硬膜外与全麻联合应用不能完全抑制胸部手术病人的应激反应,硬膜外应用利多卡因浓度高则应激反应抑制程度高;对老年病人,尤其是并缺血性心脏病病人,采用硬膜外复合全麻时,硬膜外用药以选用低浓度利多卡因为宜。

THE EFFECT OF GENERAL ANESTHESIA COMBINED WITH EPIDURAL ANESTHESIA WITH DIFFERENT CONCENTRATIONS OF LIDOCAINE ON ELDERLY PATIENTS UNDERGOING THORACIC SURGERY

Objective To study the effect of general anesthesia combined with epidural anesthesia,with different concentrations of lidocaine,on blood pressure （BP）, heart rate （HR）, level of Mood cortisol and angiotensin Ⅱ of elderly undergoing thoracic surgery. Methods Forty patients, ASA physical status Ⅰ- Ⅱ , age 60-78 years, scheduled for lobectomy of lung under the combined anesthesia were evenly randomized to receive either lidocaine 0.5% （Group A） or lidocaine 1% （Group B）. BP and HR were measured every 5 min during anesthesia. Blood samples were taken before anesthesia, 5 and 30 minutes after incision, and the first day after surgery for cortisol and angiotensin Ⅱ detection. Results The systolic blood pressure （SBP） of five and 30 minutes after incision and at the end of surgery in both groups was lower than prior to anesthesia （t= 2. 482-11. 261, P〈0.05）. The SBP of 30 minutes after incision and at the end of surgery in group B was lower than that in group A （t= 2. 269,6. 066;P〈 0.05）. In group B, the HR of five and 30 minutes after incision was lower than before anesthesia （t= 2. 290,2. 635;P〈0.05）. The level of angiotensin Ⅱ of 30 minutes after incision was higher than that of before anesthesia （t= 3. 561,4. 030;P〈0.05）, the level of cortisol of 30 minutes after incision and the first day after surgery was bighter than that before anesthesia （t= 2. 171- 4. 849,P〈0.05）, there was no significant difference in concentration of angiotensin Ⅱ and cortisol between the two groups （P〉 0.05）. In group B, five patients needed vasoconstrictor to maintain Mood pressure. Conclusion The combination of general and epidural anesthesia incompletely inhibits the stress of thoracic surgery, the bighter the concentration of lidocaine used, the bighter the degree of stress inhibited, but for senior patients, with ischemic heart disease in particular, using low concentration of lidocaine in epidural anesthesia is advocated.