老年开胸手术全麻、硬膜外复合—持续硬膜外镇痛模式探讨

Clinical Observation of CGEA-CCEA for Senile Thoracotomy

【目的】探讨老年开胸手术全麻、硬膜外复合 持续硬膜外镇痛 (CCEA)模式的效应与安全性。【方法】老年开胸肺叶切除病人 80例 (排除脑血管疾病、糖尿病 ) ,年龄 6 5～ 79(70 .2± 3.1)岁 ,ASAⅡ～Ⅲ级 ,以全麻、硬膜外 CCEA模式为观察组 ,静吸互补全麻为对照组 ,每组 4 0例。当收缩压下降≥ 2 5 %基础值、心率减缓≤6 0次 /min予麻黄碱、阿托品纠正和规范输液 ,统计分析两组心率、血压改变例数与纠正使用麻黄碱、阿托品的用量和术毕苏醒拔管时间与需入PACU复苏的例数和术后并发症的发生率来评估其效应与安全性。【结果】两组麻醉诱导时均有明显的循环改变 ,组内比较差异有显著性 (P <0 .0 5 ) ,组间比较差异无显著性 (P >0 .0 5 )。术毕苏醒时间与入PACU复苏例数和术后并发症发生率观察组明显低于对照组 ,两组比较差异有显著性 (P <0 .0 5 )。【结论】老年开胸手术全麻、硬膜外复合—CCEA模式具有较单纯吸静互补全麻用药量小、易苏醒早期拔管和在扩容治疗前提下术中循环稳定、术后镇痛完善并发症发生少的特点 ;安全有效可临床推广应用。

ObjectiveTo investigate the effect and safety of Combination of General Anesthesia with Epidural Anesthesia -CCEA for senile thoracotomy.Eighty senile cases(ASA Ⅱ～Ⅲ stage)for pneumonectomy were chosen (excluding cerebrovascular disease and diabetes). They were divided into two groups, the observation group and the control group (general anesthesia achieved by administering a combination of gas and injection). Ephedrine or atropine were used for correction during decrease of SBp≥25% of the basic value, HR≤60/min. The effect and safety were assessed according to the number of the cases with heart rate and blood pressure changed. The dose of ephedrine and atropine used to correct circulation, the length of the time for waking up and removing the tracheal cannula and the number of cases needed to be sent to PACU were compared.The circulation changes were similar in two groups before and after anesthesia(P>0.05),but they were different in the same group before and after anesthesia(P<0.05).Wake-up time,cases sent to PACU,postoperative complication rate were less in the observation group than in the control group(P<0.05).[Conclusion]CGEA-CCEA for senile thoracotomy has the advantages of less drug used,wake-up earlier,removing intratracheal cannula earlier,less patient sent to PACU,circulatory stability under infusion,complete postoperative analgesia,less complications.It is effective and safe and can be used widely.