全麻复合硬膜外阻滞用于老年患者腹部手术临床研究

Clinical research of general anesthesia combined with epidural block in the elderly patients with abdominal operation

目的:探讨全麻复合硬膜外阻滞在老年患者手术中应用的可行性和优越性.方法: 老年患者择期腹部手术420例,平均73.4岁,ASA I～Ⅲ级.随机分为单纯全麻组(G组)和全麻复合硬膜外阻滞组(GE组).GE组于T8～9或T9～10行常规硬膜外穿刺,分1～2次给予1% 利多卡因+ 0.25% 丁卡因混合液7～13 mL,并控制平面在T4～5到T12～L1.先后静脉注射咪唑安定、丙泊酚、芬太尼、阿曲库铵行全麻诱导及气管插管.间断静脉注射芬太尼、阿曲库铵和持续静脉滴注丙泊酚4～6 mg/(kg .h )维持麻醉,关腹时停止全麻给药.术毕待患者清醒,呼吸恢复良好拔除气管导管.G组不施行硬膜外阻滞,全麻过程同GE 组.取入室后20 min(T0)、插管时(T1)、切皮时(T2)、手术30 min(T3)、手术60 min(T4)、手术90 min(T5)、拔管后(T6)7个时间点,分别记录即刻的MBP、HR、SpO2.T0作为基础值.结果:G组MBP、HR在插管、切皮、拔管时显著升高,且全过程波动很明显,而GE 组在全过程比较平稳.两组SpO2在插管及手术过程中无差别,拔管后GE 组明显高于G组.结论:全麻复合硬膜外阻滞是老年患者较为理想的麻醉方法.

Objective To discuss the feasibility and advantage of general anesthesia combined with epidural block in the elderly patients with abdominal operation. Methods Four hunclred and twenty aged patients, ASA Ⅰ-Ⅲ were randomly divided into 2 groups, GA group （210 patients） receiving general anesthesia combined with epidural block and G group （210 patients） receiving pure general anesthesia. The analgetic plane was lower than T4. Main blood pressure, heart rate and SpO2 were detected before anesthesia （T0）, at intubation （T1）, at skin insicion （T2）, at 30 minutes （T3）, 60 minutes （T4）, 90 minutes （Ts） after skin incision,and at extubation（T6）. Results Main blood pressure and heart rate detected at the time point of T1, T2and T6in GE group were significantly higher than basal values, but main blood pressure at T3 was obviously lower. However, main blood pressure and heart rate were stable in GE group. SpO2 in GE group was higher than in G group after extubation. Conclusion General anesthesia combined with epidural block is a better method of anesthesia in the elderly patients with surgical operation.