联合腰麻和硬膜外麻醉在前列腺摘除围手术期的临床应用

The Clinical Use of Combined Spinal-Epidural Anesthesia in The-Operation of Prostate Extirpation

目的:研究腰硬联合麻醉用于前列腺摘除手术及术后镇痛的可行性和安全性。方法:观察病例随机分成连续硬膜外阻滞(CEA)组和腰硬联合麻醉(CSEA)组,常规操作,严格控制麻醉平面,术毕确定无全脊麻征象后行病人自控硬膜外镇痛。记录术中生命体征(血压、心率、呼吸),阻滞完善时间,阻滞平面,有无寒战、恶心呕吐,出血量、输血输液量,术中麻醉效果,术后头痛及术后镇痛效果。结果:两组血压下降、心率下降、麻醉平面过高(>T6)、寒战、恶心呕吐、失血量、输血液量及术后头痛等无显著差异,但两组阻滞完善时间比较有显著差异(P<0.01);两组麻醉效优者共73.1%,CSEA组效优者明显高于CEA组(P<0.05);术后CEA组、CSEA组各有12例和2例加用肌注镇痛药,VSA评分2以内两组比较CSEA组较CEA组效果更好(P<0.05)。结论:腰硬联合麻醉应用于前列腺摘除术是一种麻醉效果满意、术后镇痛效果确切、安全性高的麻醉方法。

Objective： To investigate the feasibility and safety of combined spinal-epidural anesthesia used in anesthesia and analgesia for prostate extirpation. Methods Patients were divided into two groups randomly： Groups CEA and CESA. Everything was operated routinely and anesthesia levels were controlled. After operations patient-controlled epidural analgesia （PCEA） was conducted with the assurance of no all-lumbar anesthesia. Record the vital signs, acting time anesthesia levels, side-effects such as shivering, headache, nausea and vomiting, bleeding, liquid and blood transfusion. Results There was no significant differences between the two groups in the decreases of blood pressure and heart rate, shivering, nausea, vomiting, headache, bleeding, liquid and blood transfusing, and too high anesthesia level （〉T6）. But significant difference existed in the acting time of these two groups （P〈0.01） ; the number of good effect in group CESA was much bigger than that in Group CEA （P〈0.05） ; after operations there were 12 patients of Group CEA and 2 patients of Group CESA needed extra analgesia via injection; patients of score of VAS below 2 in Group CESA was much fewer than that in Group CEA （P〈0.05）. Conclusion Combined spinal-epidural anesthesia is an idea way for prostate extirpation.