单侧腰部麻醉和全身麻醉对老年患者髋关节置换术应激反应影响的对比研究

目的：探讨轻比重布比卡因单侧腰部麻醉（以下简称腰麻）和全身麻醉（以下简称全麻）在老年患者髋关节置换术中的效果，以及对患者应激反应的影响。方法选择2013年12月至2014年11月在该院行髋关节置换术的老年患者40例，按照随机数字表法分为单侧腰麻组和全麻组，各20例，于麻醉前10 min（T0）、术毕（T1）和术后24 h（T2），采集患者静脉血测定血糖（GLU）、血清儿茶酚胺（CA）及皮质醇（CORT）浓度，记录其血压平均动脉压（MAP）、心率（HR）和脉搏血氧饱和度（SpO2），以及术中不良反应与术后相关并发症的发生情况，分别评定麻醉效果并进行比较分析。结果两组患者均顺利完成手术，麻醉效果满意。术中单侧腰麻组患者低血压、高血压及心动过缓的发生率均低于全麻组，差异均有统计学意义（P＜0．05）。T1时两组患者HR、MAP均降低，但组间比较差异均无统计学意义（P＞0．05）；GLU、CORT、CA水平均升高，且组间比较差异均有统计学意义（P＜0．05）。T2时全麻组患者SpO2低于单侧腰麻组，CORT高于单侧腰麻组，差异均有统计学意义（P＜0．05）。术后单侧腰麻组患者恶心呕吐、咽喉痛、头晕嗜睡及肺部感染的发生率均低于全麻组，差异均有统计学意（P＜0．05）。结论轻比重布比卡因单侧腰麻和全麻在老年患者髋关节置换术中均能提供良好的麻醉效果，而轻比重布比卡因单侧腰麻更能有效地调控老年患者髋关节置换术的应激反应。

Comparative study on influence of unilateral lumbar anesthesia and general anesthesia on stress responses in elderly hip replacement

Objective To explore the effect of the unilateral lumbar anesthesia by hypobaric bupivacaine and general anesthe‐sia in elderly hip replacement and their influence on the stress response .Methods Forty elderly patients undergoing hip replace‐ment in our hospital from December 2013 to November 2014 were selected and randomly divided into the unilateral lumbar anesthe‐sia group and general anesthesia group according to the random number table ,20 cases in each group .Venous blood was collected to determine the levels of blood sugar ,serum catecholamine(CA) and cortisol(CORT ) at 10 min before anesthesia(T0 ) ,end of surgery (T1 ) and at postoperative 24 h(T2 ) .MAP ,HR ,SpO2 ,intraoperative adverse reactions and postoperative related complications were recorded at each time point ,and the comparative analysis was performed .Results All patients successfully completed surgery and the anesthetic effect was satisfied .The occurrence rates of intraoperative hypotension ,hypertension and bradycardia in the unilateral lumbar anesthesia group were lower than those in the general anesthesia group ,the differences had statistical significances (P>0 .05) .HR and MAP at T1 in the two groups were reduced ,but the differences between the two groups were no statistical signifi‐cance(P>0 .05);the levels of GLU ,CORT and CA were increased ,moreover the differences between the two groups were statisti‐cally significant(P<0 .05) .SpO2 at T2 in the general anesthesia group was obviously lower than that in the unilateral lumbar anes‐thesia group ,while CORT was higher than that in the unilateral lumbar anesthesia group ,the differences were statistically signifi‐cant(P<0 .05) .The occurrence rates of postoperative nausea and vomiting ,sore throat ,dizziness ,drowsiness and pulmonary infec‐tion in the unilateral lumbar anesthesia group were lower than those in the general anesthesia group ,the differences were statistical‐ly significant(P<0 .05) .Conclusion The unilateral lumbar anesthesia by using hypobaric bupivacaine and general anesthesia all could offer better anesthetic effect .The unilateral lumbar anesthesia by using hypobaric bupivacaine can effectively regulate the stress response in elderly patients with hip replacement .