麻醉方式：复合麻醉好吗？

本文由“小麻哥的日常"授权转载

摘要译文

老年慢阻肺患者全麻复合腰麻的临床观察 目的： 评价老年慢阻肺（COPD）患者全身麻醉（GA）联合腰麻（SA）（GA+SA）的有效性和安全性。 方法和材料： 将50例老年COPD患者随机分为对照组（单纯GA）和观察组（GA+SA）。 手术时间、术后恢复时间（PRT）、语言表达时间（LET）、麻醉剂量（AD）、导管拔管时间（CET）、呼吸循环指标（平均动脉压（MAP）、心率（HR）、SaO2和PaO2）、术后VRS评分、肺功能（用力肺活量（FVC）），分析1s用力呼气量（FEV1）/FVC和用力呼气流量（FEF 25%~75%）、血清炎症因子（IL-6、IL-8和TNF-α）、简易便携式精神状态问卷（SPMSQ）评分以及呼吸系统事件的发生率。 结果： 观察组的PRT、LET、AD和CET均较对照组短（P<0.05）。 GA+SA组术后MAP、HR、SaO2和PaO2水平明显高于单纯GA组（P<0.05）。 观察组术后VRS评分优于对照组（P<0.05）。 观察组术后肺功能优于对照组（P<0.05）。 观察组术后血清炎症因子低于单纯GA组（P<0.05）。 GA+SA组术后认知功能SPMSQ评分低于单纯GA组（P<0.05）。 观察组发生呼吸系统事件的概率较低（P<0.05）。 结论： 综上所述，GA+SA可显著缩短老年COPD患者的PRT，提高其康复质量。还可减少术后炎症反应，增强肺功能和认知功能。它还增强了镇痛作用，有利于患者术后恢复。因此，GA+SA是老年COPD患者高效、安全的麻醉方法，值得临床应用。

图1手术相关指标的比较。 ∗：P<0.05。

图2围手术期MAP和HR的变化。 ∗, #, 与对照组在T0时的值、观察组在T0时的值和对照组在同一时间点的值相比，显示P<0.05。

图3围手术期SaO2和PaO2的变化 与观察组在T0时的值和对照组在同一时间点的值相比，P<0.05。

图4围手术期BUN和Scr的变化。 ∗, #, 与对照组在T0时的值、观察组在T0时的值和对照组在同一时间点的值相比，显示P<0.05。

图5 VRS疼痛评分的比例。

图6肺功能指标的变化。 ∗和#分别表示手术前后与对照组相比P<0.05。

图7围手术期血清炎症因子的变化。 ∗, #, 与手术前对照组和观察组的值以及手术后对照组的值相比，P<0.05。

图8围手术期SPMSQ评分比较。 ∗, #, 与对照组和观察组手术前的评分以及对照组在同一时间点的评分相比，P<0.05。

图9围手术期肌电图信号P3潜伏期和振幅的变化。 ∗, #, 手术前对照组和观察组的值与同一时间点的对照组的值相比均P<0.05。

图10术后呼吸系统事件比较。 I~V分别指肺部感染、肺不张、支气管痉挛、支气管镜检查和NPPV支持。 原文摘要 Clinical Observation of General Anesthesia Combined with Spinal Anesthesia in Elderly Patients with Chronic Obstructive Pulmonary Disease Objective: This work is aimed at evaluating the efficacy and safety of general anesthesia (GA) combined with spinal anesthesia (SA) (GA+SA) in elderly patients with chronic obstructive pulmonary disease (COPD). Methods and Material. 50 elderly COPD patients were rolled randomly into a control group (simple GA) and observation group (GA+SA). The differences in operation time, postoperative recovery time (PRT), language expression time (LET), anesthetic dosage (AD), catheter extubation time (CET), respiratory circulation indicators (mean arterial pressure (MAP), heart rate (HR), SaO2, and PaO2), postoperative VRS score, pulmonary function (forced vital capacity (FVC)), forced expiratory volume in 1 s (FEV1)/FVC and forced expiratory flow (FEF 25%~75%), serum inflammatory factors (IL-6, IL-8, and TNF-α), Short Portable Mental Status Questionnaire (SPMSQ) score, and the incidence of respiratory system events were analyzed. Results: The results showed that the PRT, LET, AD, and CET of the observation group were all shorter (P < 0.05). The postoperative MAP, HR, SaO2, and PaO2 levels of patients who received GA+SA were much higher than those who received simple GA (P < 0.05). The postoperative VRS score of the observation group was better than that of the controls (P < 0.05). The postoperative pulmonary function of patients in the observation group was better compared with that in the control group (P < 0.05). The postoperative serum inflammatory factors in the observation group were lower in contrast to the patients who received simple GA (P < 0.05). The postoperative cognitive function SPMSQ score of patients who received GA+SA was lower compared with the score of patients who received simple GA (P < 0.05). However, the probability of respiratory system events in the observation group was lower (P < 0.05). Conclusion: In conclusion, GA+SA could significantly shorten the PRT and improve the recovery quality of elderly COPD patients. It can also reduce the postoperative inflammatory response and strengthen the pulmonary function and cognitive function. It also enhances the analgesic which is beneficial to patients' postoperative recovery. Therefore, GA+SA was a highly effective and safe anesthesia method for elderly patients with COPD, and it was worthy of clinical application. Figure 1 Comparison of surgery-related indicators. ∗ meant P < 0.05. Figure 2 Changes in MAP and HR during the perioperative period. ∗, #, and & indicated P < 0.05 compared with the value of the control group at T0, the value of the observation group at T0, and the value of control at the same time point, respectively. Figure 3 Changes in SaO2 and PaO2 during the perioperative period. # and & suggested P < 0.05 in contrast to the value of the observation group at T0 and the value of the control group at the same time point, respectively. Figure 4 Changes in BUN and Scr during the perioperative period. ∗, #, and & indicated P < 0.05 compared with the value of the control group at T0, the value of the observation group at T0, and the value of control at the same time point, respectively. Figure 5 The proportion of VRS pain scores. .Figure 6 Changes in pulmonary function indicators. ∗ and # indicated P < 0.05 in contrast to the controls before and after the surgery, respectively. Figure 7 Changes in serum inflammatory factors during the perioperative period. ∗, #, and & suggested P < 0.05 compared to the value in the control group and the observation group before the surgery and the value of the control group after the surgery, respectively. Figure 8 Comparison of SPMSQ score during the perioperative period. ∗, #, and & indicated P < 0.05 in contrast to the scores before the surgery in the control and observation groups and the score of the control group at the same time point, respectively. Figure 9 Changes in P3 latency and amplitude of EMG signal during the perioperative period. ∗, #, and & meant P < 0.05 to the value in the control and observation groups before surgery and that in the control group at the same time point, respectively. Figure 10 Comparison of postoperative respiratory system events. I~V referred to pulmonary infection, atelectasis, bronchospasm, bronchoscopy, and NPPV support, respectively.