硬膜外麻醉复合全身麻醉、单纯全身麻醉对老年腹部手术患者心肌损伤的情况比较

目的 对比硬膜外麻醉复合全身麻醉、单纯全身麻醉对老年腹部手术患者心肌损伤的情况。方法 100例老年腹部手术患者,根据麻醉方法不同分为对照组与观察组,各50例。对照组采取单纯全身麻醉,观察组采取硬膜外麻醉复合全身麻醉。比较两组患者手术麻醉前、术后6 h、12 h活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)、血小板计数(PLT)水平;心肌功能水平,包括肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)水平;麻醉清醒时间和苏醒期躁动发生率;手术麻醉前、切皮时、术中30 min、术后血流动力学情况,包括心率(HR)和平均动脉压(MAP)水平;心脏不良事件发生情况。结果 观察组患者术后6、12 h APTT、PT、TT均短于对照组, FIB水平低于对照组, PLT水平高于对照组,差异有统计学意义(P<0.05)。观察组患者术后6 h CK-MB与c TnI水平分别为(1.33±0.63)U/L与(0.19±0.11)μg/L均低于对照组的(1.61±0.71)U/L与(0.37±0.12)μg/L,术后12 h CK-MB与cTnI水平分别为(1.63±0.95)U/L、(0.23±0.18)μg/L均低于对照组的(2.58±1.08)U/L与(0.41±0.17)μg/L,差异有统计学意义(P<0.05)。观察组患者麻醉清醒时间(21.01±8.24)min显著短于对照组的(34.52±11.20)min,苏醒期躁动发生率4.00%显著低于对照组的16.00%,差异有统计学意义(P<0.05)。观察组患者切皮时、术中30 min HR、MAP水平均显著低于对照组,差异有统计学意义(P<0.05)。观察组患者心脏不良事件发生率24.00%显著低于对照组的66.00%,差异有统计学意义(P<0.05)。结论 与单纯全身麻醉相比,老年腹部手术患者采取硬膜外麻醉复合全身麻醉的效果更为显著,对心肌功能损伤更小,可降低其凝血纤溶指标水平,缩短麻醉清醒时间,降低苏醒期躁动发生率,应在临床中积极推广。

Comparison of epidural anesthesia combined with general anesthesia and simple general anesthesia on myocardial injury in elderly patients undergoing abdominal surgery

Objective To compare the effect of epidural anesthesia combined with general anesthesia and simple general anesthesia on myocardial injury in elderly patients undergoing abdominal surgery.Methods A total of 100 elderly patients undergoing abdominal surgery were divided into control group and observation group by different anesthesia methods,with 50 cases in each group.The control group received general anesthesia,and the observation group received epidural anesthesia combined with general anesthesia.The activated partial thromboplastin time(APTT),prothrombin time(PT),thrombin time(TT),platelet(PLT)count and fibrinogen(FIB)before anesthesia,6 and 12 h after operation,myocardial function[creatine kinase isoenzyme(CK-MB),cardiac troponin I(cTnI)]level,awake time of anesthesia and occurrence of emergence agitation,hemodynamic situation[heart rate(HR)and mean arterial pressure(MAP)]before anesthesia,at skin incision and 30 min after anesthesia and after operation,and occurrence of adverse cardiac events were compared between the two groups.Results In postoperative 6 and 12 h,APTT,PT and TT of the observation group were shorter than those of the control group,FIB levels was lower than that of the control group,and PLT count was higher than that of the control group.The difference was statistically significant(P<0.05).In postoperative 6 h,the levels of CK-MB and cTnI of the observation group were(1.33±0.63)U/L and(0.19±0.11)μg/L,which were lower than those of the control group(1.61±0.71)U/L and(0.37±0.12)μg/L.In postoperative 12 h,the levels of CK-MB and cTnI of the observation group were(1.63±0.95)U/L and(0.23±0.18)μg/L,which were lower than those of the control group(2.58±1.08)U/L and(0.41±0.17)μg/L.The difference was statistically significant(P<0.05).The awake time of anesthesia(21.01±8.24)min of the observation group was significantly shorter than that of the control group(34.52±11.20)min,and incidence of emergence agitation 4.00%was significantly lower than that of the control group 16.00%,and the difference was statistically significant(P<0.05).At skin incision and 30 min after anesthesia,the levels of HR and MAP of the observation group were significantly lower than those of the control group,and the difference was statistically significant(P<0.05).The incidence of adverse cardiac events 24.00%of the observation group was significantly lower than that of the control group 66.00%,and the difference was statistically significant(P<0.05).Conclusion Compared with general anesthesia,the combined effect of epidural anesthesia and general anesthesia in elderly patients undergoing abdominal surgery is more significant,and the damage to myocardial function is smaller.It can reduce the level of coagulation and fibrinolysis indicators,shorten the awakening time of anesthesia,and reduce the incidence of emergence agitation.It should be actively promoted in the clinic.