高龄患者开胸手术两种不同麻醉与镇痛方法的效果比较

Two anesthetic and analgesia methods in elderly patients undergoing thoracic surgery

目的比较高龄患者开胸手术两种不同麻醉与镇痛方法的效果。方法将28例高龄病人分成两组，Ⅰ组18例，采用全麻-硬膜外联合麻醉，术中维持用异丙酚2～3mg／（kg·h）微泵静滴及硬膜外追加1．0％利多卡因、0．25％罗哌卡因，必要时按需吸入少量异氟醚，术后行硬膜外镇痛。Ⅱ组10例，采用静吸复合全麻，术中维持用异丙酚3～4mg／（kg·h）及吸入异氟醚维持，术后行静脉镇痛。分别监测两组病人麻醉前、插管即刻、去肋开胸、手术探查、拔管时的SBP、DBP、HR，术后清醒时间，术毕躁动及术后镇痛效果情况。结果Ⅰ组病人麻醉及手术过程中，BP、HR平稳，术后患者苏醒快，苏醒质量及术后镇痛效果佳；Ⅱ组病人则BP、HR波动较大，且患者苏醒相对缓慢，苏醒质量及术后镇痛效果相对欠佳。结论Ⅰ组全麻-硬膜外联合麻醉及术后镇痛效果明显优于Ⅱ组全麻及术后静脉镇痛。

Objective To compare the effects of two anesthetic and analgesia methods in old patients undergoing thoracic surgery. Methods Twenty - eight patients were divided into two groups randdomly： 18 patients in group I received combined general - epidural anesthesia, followed by intravenous infusion of propofol 2 ～ 3mg/（ kg · h） and 1.2% lidocaine as well as 0.25% ropivacaine through epidural administration. Isoflurane was inhalated if necessary after intubation. Ten patients in group Ⅱ received complex anesthesia of intravenous drip and inhalation , infusion of propofol 3 ～ 4ml/（ kg · h） and inhalation of isoflurane. SBP,DBP,HR and the time of consciousness recovery as wall as restlessness, effect of analgesia were recorded before and after intubation and anesthesia. Group Ⅰ was received epidural analgesia and group Ⅱ received vein analgesia. Results Patients in group Ⅰ had stabler BP and HR than that in group Ⅱ ,and recovery of consciousness in group Ⅰ was quicker and better in quality as well as effect of analgesia than that in group Ⅱ. Conclusion The effect of anesthetic and analglesia method of group Ⅰ is much better than that in group Ⅱ.