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。

    关键词： 腰麻硬膜外联合神经阻滞； 老年； 血压； 肾素血管紧张素

    Variation of Neuroendocrine in Senior Patients after Combination of Spinal and Epidural Anesthesia

    YANG Guang-ping, GUO Cui-rong

    (The Affiliated Hospital of Guangdong Medical College, Guangdong Zhanjiang 524001, China)

    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 low-limb 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. ......