轻比重单侧腰麻对高血压患者髋关节置换术血流动力学及应激反应的影响

摘要

ObjectiveTo investigate the effect of hemodynamic and stress responses of hypobaric unilateral spinal anesthesia in hip replacement in patients with hypertension.Methods Retrospective analysis sixty patients with hypertension,ASA physicalⅡor Ⅲ,scheduled for hip replacement surgery were devided into two groups with 30 cases each.Group A received general spinal anesthesia and group B received hypobaric unilateral spinal anesthesia. The anesthetic effect were measured.Venous blood was taken before anesthesia(T0),the start of operation(T1),the end of operation (T2)and 12 hours after operation(T3) for determination of plasma noradrenaline(NE),adrenaline(E) and cortisol(CORT).MAP and HR at T0-3 were recorded.Results All patients achieved satisfactory block.Compared with group A,there were less changes in MAP and HR in group B at T1 and T2(P<0.05).The level of NE,E and CORT at T1,T2 and T3 were lower than group A (P<0.05). ConclusionHypobaric unilateral spinal anesthesia provided less hemodynamic changes and stress responses in hip replacement surgery in patients with hypertension.%目的：观察轻比重单侧腰麻对高血压患者髋关节置换术血流动力学及应激反应的影响。方法回顾分析研究择期髋关节置换术的患者60例，ASA分级Ⅱ～Ⅲ级，合并原发性高血压，分为两组：常规腰麻组（A组）和轻比重单侧腰麻组（B组），分别评定麻醉效果，记录麻醉前（T0）、手术开始时（T1）、手术结束时（T2）、术后12h（T3）的平均动脉血压（MAP）、心率（HR），同时在各时点抽取静脉血测定血浆中肾上腺素（E）、去甲肾上腺素（NE）、皮质醇（CORT）的浓度，记录术中及术后的不良反应。结果两组患者麻醉效果均满意，差异无统计学意义（P＞0.05）。与A组比较，B组患者在T1、T2时的MAP更高，HR更低，差异有统计学意义（P＜0.05）；与A组比较，B组患者在T1、T2、T3时的E、NE、CORT更低，差异有统计学意义（P＜0.05）；结论轻比重单侧腰麻对高血压患者髋关节置换术血流动力学影响小、应激反应轻、不良反应少，优于常规腰麻。