【摘要】 目的探讨不同麻醉方式对老年腹腔镜下手术患者应激反应、神经功能及胃肠道功能的影响。方法选择2016年5月至2019年6月在复旦大学附属华山医院接受腹腔镜手术的86例老年患者进行研究。根据入院顺序将患者均分为对照组和观察组,每组43例。对照组行全麻手术,观察组行全麻联合硬膜外麻醉。术前术后比较两组患者应激反应、神经功能及胃肠道功能。结果两组患者患者术前的皮质醇、血糖、C反应蛋白比较差异均无统计学意义(P>0.05);术后,观察组和对照组患者的皮质醇[(192.37±50.19) nmol/L vs (253.01±61.02) nmol/L]、血糖[(5.31±0.49) nmol/L vs (6.74±0.65) nmol/L]、C反应蛋白[(73.09±16.94) mg/L vs (102.15±23.08) mg/L]比较,观察组明显低于对照组,差异均有统计学意义(P<0.05);两组患者患者术前的血髓鞘碱性蛋白(MBP)、神经元特异性烯醇化酶(NSE)及S100B蛋白(S100B)比较差异均无统计学意义(P>0.05);术后观察组和对照组患者的MBP[(11.62±1.83)μg/mL vs (14.82±2.90)μg/mL]、NSE[(20.31±4.83) ng/mL vs (22.83±5.19) ng/mL]、S100B[(1.09±0.29) ng/mL vs (1.48±0.41) ng/mL]比较,观察组明显低于对照组,差异均有统计学意义(P<0.05);两组患者患者术前的胃动素、胃泌素及饥饿素比较,差异均无统计学意义(P>0.05);术后观察组和对照组胃动素[(179.03±24.35) pg/mL vs (146.39±25.82) pg/mL]及饥饿素[(37.63±6.04) pg/mL vs (34.13±5.88) pg/mL]比较,观察组明显高于对照组,差异均有统计学意义(P<0.05);但术后观察组与对照组的胃泌素为[(204.91±24.28) pg/mL vs (205.93±26.07) pg/mL]比较,差异无统计学意义(P>0.05)。结论全麻联合硬膜外麻醉与全麻相比更能缓解老年腹腔镜下手术患者应激反应,减少对神经功能及胃肠道功能的影响。更多还原

【Abstract】 Objective To investigate the effects of different anesthesia methods on stress response, neurological function, and gastrointestinal function in elderly patients undergoing laparoscopic surgery. Methods Eighty-six elderly patients who underwent laparoscopic surgery in Huashan Hospital North Campus Affiliated to Fudan University from May 2016 to June 2019 were enrolled. According to the order of admission, the patients were divided into control group and observation group, with 43 patients in each group. The control group underwent general anesthesia, and the observation group underwent general anesthesia combined with epidural anesthesia. The stress response, neurological function, and gastrointestinal function were compared between the two groups before and after surgery. Results There was no significant difference in the preoperative cortisol, blood glucose, and C-reactive protein between the two groups of patients(P>0.05). Postoperatively, the cortisol, blood glucose, C-reactive protein in the observation group were(192.37±50.19) nmol/L,(5.31±0.49) nmol/L,(73.09±16.94) mg/L, significantly lower than(253.01±61.02) nmol/L,(6.74±0.65) nmol/L,(102.15±23.08) mg/L in the control group(P<0.05). There was no significant difference in blood myelin basic protein(MBP), neuron specific enolase(NSE), and S100 B protein between the two groups before surgery(P>0.05). After operation, MBP, NSE, S100 B in the observation group were(11.62 ± 1.83) μ g/mL,(20.31 ± 4.83) ng/mL,(1.09±0.29) ng/mL, significantly lower than(14.82±2.90) μg/mL,(22.83±5.19) ng/mL,(1.48±0.41) ng/mL in the control group(P<0.05). There was no significant difference in the levels of motilin, gastrin, and hungryin between the two groups before surgery(P>0.05); the levels of motilin and hungryin were(179.03±24.35) pg/m L and(37.63±6.04) pg/m L, significantly higher than(146.39±25.82) pg/m L and(34.13±5.88) pg/m L in the control group after surgery(P<0.05). There was no significant difference in gastrin between the two groups:(204.91 ± 24.28) pg/m L vs(205.93 ± 26.07) pg/m L, P>0.05.Conclusion General anesthesia combined with epidural anesthesia can relieve the stress response and reduce the effects on neurological function and gastrointestinal function in elderly patients undergoing laparoscopic surgery.更多还原