【摘要】 目的:探讨腰麻硬膜外联合神经阻滞后老年患者神经内分泌的变化,评估老年患者应用腰麻硬膜外联合神经阻滞的可行性。方法:随机选择老年择期手术患者(>65岁)30例,在腰麻硬膜外联合神经阻滞麻醉下行下腹部及下肢手术。测量并记录患者入室后麻醉前、麻醉后30min、60min和术毕皮质醇、肾素活性(PRA)、血管紧张素(A)和醛固酮(AL)含量;观察并记录患者入室平静后、给药后5min、10min、15min、30min、60min收缩压(SBP)、舒张压(DBP)、心率(HR)、脉搏血氧饱和度(SPO2)变化,并观察患者有无心律失常及心肌缺血等并发症。结果:患者麻醉后生命征平稳,各指标均无明显变化(P>0.05),血压下降幅度均<20%,未发生心律失常、心肌缺血加重等心电图改变;麻醉后和术毕肾素活性(PRA)含量明显降低(P<0.05)。结论:腰麻硬膜外联合神经阻滞对老年患者神经内分泌功能具有抑制作用,有利于心血管疾病患者,在老年患者可以安全使用,但应注意平面控制。更多还原

【Abstract】 Objective: To explore variation of neuroendocrine in senior patients after combination of spinal and epidural anesthesia and its clinical feasibility.Methods: 30 senior patients undergoing sub-abdominal and lowlimb operation were selected and anesthetized with CSE.DBP,SBP,SPO₂,HR,ECG at 5min,10min,15min,30min and 60min after 8 mg hyperbaric bupivacaine was administered subarachnoidly were observed and recorded.Plasma rennin,angiotensin Ⅱ and aldosterone levels were measured at the point of preanesthesia and 30mins,60mins after anesthesia and the end of surgery.Results: All the hemodynamics measurements were normal and there was no significant variation after CSE.No arrhythmia and cardiac ischemia occurred.The level of plasma rennin dropped significantly after anesthesia（P<0.05）.Conclusion: CSE can be safely used in senior patients with well control of block-area and volume-expansion in low dosage and can reduce the level of plasma rennin and may be good to the senior with cardiovascular complication.更多还原