神经阻滞复合全麻对老年病人膝关节置换术应激反应的影响

目的观察腰丛-坐骨神经联合阻滞复合全麻对老年病人膝关节置换术应激反应的影响。方法 50例行单侧全膝关节置换手术病人,分为两组,即神经阻滞复合全麻组(C组,n=25)与单纯全麻组(G组,n=25),分别测定麻醉诱导前(T0)、手术切皮时(T1)、手术30min(T2)、手术结束时(T3)和术后1h(T4)血清白介素-6(IL-6)、皮质醇(COR)、肾上腺素(E)和去甲肾上腺素(NE)的浓度。结果 (1)IL-6:与T0比较C组在T4时升高,G组在T1-T4时均升高,差异有统计学意义(P<0.05)。(2)COR:与T0比较C组在T2-T4时均升高,G组在T1-T4时均升高,差异有统计学意义(P<0.05)。(3)E:与T0比较C组差异无统计学意义(P>0.05),G组在T1-T4时均升高,差异有统计学意义(P<0.05),T2-T4与T1,T3、T4与T2,T4与T3比较差异有统计学意义(P<0.05)。(4)NE:与T0比较C组差异无统计学意义(P>0.05),G组在T1-T4时均升高,差异有统计学意义(P<0.05),T4与T1比较差异有统计学意义(P<0.05)。(5)组间比较:上述各指标在T1-T4时G组较C组均增高,差异有统计学意义(P<0.05)。结论腰丛-坐骨神经联合阻滞复合全麻较单纯全麻能更有效的抑制老年病人围术期应激反应的产生。

Effects of Nerve Block Combined General Anesthesia on Stress Response in Elder Patients with Lower Limb Surgery

Objective To investigate the effects of the lumbar plexus sciatic never block combined general anesthesia on stress response in elder patients with lower limb surgery.Methods 50 old patients subject to unilateral lower limb operation were assigned to two groups: never block combined general anesthesia(group C,n = 25),general anesthesia(group G,n = 25).Blood samples were taken before anesthesia(T 0),at the beginning of the surgery(T 1),30 min after the beginning of surgery(T 2),at the end of the surgery(T 3),60 min after the end of surgery(T 4) for determination of interleukin-6(IL-6),Cortisol(COR),epinephrine(E) and Norepinepherine(NE).Results IL-6 was significantly increased at T 4 in group C and at T 2 - T 4 in group G compared with T 0(P <0.05).COR was significantly increased at T 2 - T 4 in group C and at T 1 - T 4 in group G compared with T 0(P <0.05).E and NE were not significantly increased at T 1 - T 4 in group C compared with T 0(P <0.05).IL-6,COR,E and NE were significantly increased at T 1 - T 4 in group G than those in group C at the same time.Conclusion The lumbar plexus and sciatic nerve block combined general anesthesia can be more effectively inhibit stress response than general anesthesia in elderly patients.