ERAS+非气管插管保留自主呼吸对老年腹腔镜全麻手术患者术后应激反应的影响题录

目的探讨加速康复外科(ERAS)+非气管插管保留自主呼吸对老年腹腔镜全麻手术患者术后应激反应的影响。方法本研究为随机对照试验。选择2020年1月至2022年1月在巴彦淖尔市医院进行腹腔镜全麻手术的老年患者86例为研究对象, 开展前瞻性研究, 简单随机分为观察组和对照组, 两组均为43例。观察组男性29例, 女性14例, 年龄为(76.92±6.27)岁, 采用ERAS护理+非气管插管保留自主呼吸全麻;对照组男性26例, 女性17例, 年龄为(75.86±6.93)岁, 采用常规护理+双腔支气管插管单肺通气全麻。比较两组患者手术前后血流动力学指标[心率(HR)、收缩压(SBP)、舒张压(DBP)]、应激反应指标[C反应蛋白(CRP)、皮质醇(Cor)、肾上腺素(Adr)]、动脉血氧饱和度(SaO2)、动脉血二氧化碳分压(PaCO2)、焦虑情况[汉密尔顿焦虑量表(HAMA)、焦虑自评量表(SAS)评分]变化以及术后并发症发生情况。计量资料采用t检验, 计数资料采用χ2检验。结果手术后观察组HR(77.67±7.91)次/min、SBP(135.05±9.21)mmHg(1 mmHg=0.1...

Effect of ERAS + non endotracheal intubation reserved spontaneous respiration on the stress response in elderly patients after laparoscopic general anesthesia surgery

Objective　To explore the effect of enhanced recovery after surgery (ERAS) + non endotracheal intubation reserved spontaneous respiration on the stress response in elderly patients after laparoscopic general anesthesia surgery. Methods　It was a randomized controlled trial. A total of 86 elderly patients who underwent laparoscopic general anesthesia surgery in Bayannur City Hospital from January 2020 to January 2022 were selected as the study subjects for a prospective study. They were simply randomly divided into an observation group and a control group, with 43 patients in each group. The observation group consisted of 29 males and 14 females; the age was (76.92±6.27) years old; ERAS nursing + non endotracheal intubation reserved spontaneous respiration was used for general anesthesia. The control group consisted of 26 males and 17 females; the age was (75.86±6.93) years old; regular nursing + one lung ventilation with double lumen bronchial intubation was used for general anesthesia. The changes of hemodynamic indexes [heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP)], stress response indexes [C-reactive protein (CRP), cortisol (Cor), and adrenaline (Adr)], arterial oxygen saturation (SaO₂), arterial partial pressure of carbon dioxide (PaCO₂), and anxiety [scores of Hamilton Anxiety Scale (HAMA) and Self-rating Anxiety Scale (SAS)] before and after surgery and postoperative complications were compared between the two groups. t test was used for the measurement data and χ² test was used for the count data. Results　After surgery, the HR [(77.67±7.91) beats/min], SBP [(135.05±9.21) mmHg (1 mmHg=0.133 kPa)], and DBP [(82.01±7.13) mmHg] in the observation group were lower than those in the control group [HR (87.25±8.53) beats/min, SBP (138.94±8.0) mmHg, and DBP (85.48±7.26) mmHg] (all P<0.05). After surgery, the levels of CRP [(73.95±15.29) mg/L], Cor [(113.77±4.25) nmol/L], and Adr [(197.25±6.71) pmol/L] in the observation group were lower than those in the control group [CRP (85.67±16.51) mg/L, Cor (120.51±3.17) nmol/L, and Adr (213.37±7.22) pmol/L] (all P<0.05). After surgery, the SaO₂ of the observation group was lower than that of the control group [(94.25±1.58) % vs. (95.23±2.17) %], and the PaCO₂ of the observation group was higher than that of the control group [(56.96±4.87) p/kPa vs. (46.57±4.21) p/kPa] (both P<0.05). The HAMA score and SAS score of the observation group were lower than those of the control group [(12.67±4.13) vs. (15.93±2.36), (55.38±2.61) vs. (62.07±2.84)] (both P<0.05). The incidence of postoperative complications in the observation group was lower than that in the control group [11.63% (5/43) vs. 39.53% (17/43)] (χ²=8.796, P=0.003). Conclusion　ERAS + non endotracheal intubation reserved spontaneous respiration can reduce the stress response in elderly patients after laparoscopic general anesthesia surgery, alleviate the anxiety, and promote the patients' recovery, with a low complication rate, which is recommended for clinical application.