硬膜外试验剂量在老年人麻醉中的可靠性

The Reliability of Epidural Test Dose in the Elderly

硬膜外麻醉病人70例。≥60岁和<60岁各35例。按自身交叉随机设计原则先后硬膜外或iv2%利多卡因3ml(含肾上腺素15μg)。iv后老年组和非老年组HR分别增快18.8±8.60bpm和29.3±16.64bpm,P<0.01;分别有11例和32例有自觉症状,P<0.01。单独据症状或HR判断试验剂量是否注入血管,准确性分别为老年组84.2%或88.5%,非老年组95.7%或94.2%;联合判断时老年组和非老年组分别为90.0%和95.7%。提示含肾上腺素硬膜外试验剂量在老年人麻醉中可靠性较差。

The reliability of epinephrine (EP)-containing epidural test dose in the elderly (≥60y)and in the non-elderly were studied in 70 patients. The duplicate (intravenous and epidural) injection of 3 ml of 2% lidocaine (5μg ·ml^(-1) epinephrine) were performed in random, self-cross-over design. The results showed: 1. The peak-to-peak HR in the elderly and non-elderly were 18.8±8.60 bpm and 29.3±16.64 bpm respectively (P<0.01);2. The side ef- fects occured in 11 old and 32 young patients (P<0.01), when the test dose were given Ⅳ. 3. If the diagnostic standard for epidural-venous injection of test dose was an increase in HR by 10 bpm using peak-to-peak criteria or an experience of side effects, the accuracy were 88.5% or 84.25% in the elderly and 94. 2% or 95.7% in the young. 4. When the two criteria were combined, the accuracy in the eldely and in the non-elderly would rise to 90.0% and 95. 7% respectively.