硬膜外阻滞联合全麻对老年腹部手术应激反应的影响

目的：探讨高容量0.125%罗哌卡因硬膜外阻滞联合全麻对老年胃癌根治术患者术中抑制应激反应及稳定血液动力学的作用。方法：45例患者随机A组、B组和C组,3组患者经T8-9椎间隙穿刺硬膜外腔置管,然后分别注入0.125%罗哌卡因、0.375%罗哌卡因和0.9%氯化钠0.085mL/cm身高,A、B组要求阻滞范围上至T4～T5、,下至T12～L1,全麻后机械通气。手术开始后以微量注射泵持续行硬膜外腔注射,每小时为首剂量1/3,定时检测血浆肾上腺素、皮质醇与血糖等浓度。结果：与C组相比,A组和B组血浆肾上腺素、皮质醇和血糖浓度在T4和T5时点明显降低（P〈0.05）,A组与B组之间血浆肾上腺素和血糖浓度在各时点均无明显差异（P〉0.05）。C组芬太尼用量与其余两组比较明显增加（P〈0.05）;B组输液量比其余两组明显增加（P〈0.05）。结论：全麻联合高容量0.125%罗哌卡因行硬膜外阻滞能有效抑制全麻下老年患者行胃癌根治术时的应激反应,且血流动力学平稳。

Effects of Combined General Anesthesia with Epidural Anesthesia Induced by High Capacity and Low Density Ropivacaine on Stress Response During Abdominal Operations in Gerontal Patients

Objective To investigate the feasibility and validity of combined general anesthesia with epidural anesthesia induced by high capacity 0.125% ropivacaine during gastric cancer radical correction in gerontal patients.Methods Forty-five ASA classⅠ~Ⅲ patients undergoing gastric cancer radical corrections were randomly divided into 0.125% ropivacaine group （group A）、0.375% ropivacaine group （group B） and 0.9% sodium chloride group （group C）.0.125% ropivacaine、 0.375% ropivacaine or 0.9% sodium chloride were pumped into cavitas epiduralis with the 1/3 first dosage every hour from the beginning of operations.MAP、HR and CVP were monitored and the concentration of adrenaline、corticosteroid and blood glucose were monitored.Results Compared with group C,the concentration of adrenaline、corticosteroid and blood glucose in group A and group B decreased obviously at T4 and T5 （P 0.05）;the concentration of adrenaline、corticosteroid and blood glucose were not apparently different in group A and group B during operation （P 0.05）;The dosage of ropivacaine in group A （28±4mg） was significantly lower than in group B （85±5mg） （P 0.05）;The dosage of fentanyl in group C （410±63mg）was significantly higher than in the other two groups （P 0.05）.The dosage of transfusion in group B （2770±230mL） was significantly more than other two groups （P 0.05）.Conclusion General anesthesia combined with epidural anesthesia induced by high capacity 0.125% ropivacaine can restrain stress reaction effectively and provide stable haemodynamics during gastric cancer radical correction in gerontal patients.