连续腰麻与连续硬膜外麻醉用于高危老年患者下肢手术的比较

Comparison between the application of continuous spinal anesthesia and epidural anesthesia in lower extremities operations for elderly patients with high risk status

目的探讨连续腰麻用于应用于高危老年患者下肢手术的可行性。方法40例拟行下肢手术的老年患者,年龄68～101岁,ASAⅢ～Ⅳ级,按手术种类配对,患者随机分为硬膜外麻醉组(EA组)、连续腰麻醉组(CSA组),每组20例。EA组按常规行硬膜外麻醉,CSA组按常规行连续腰麻。于麻醉前(T0,基础值)、麻醉平面满意时(T1)、切皮后1h(T2)、术毕时(T3)抽取动脉血测乳酸浓度,常规监测动脉压(ABP)、心率(HR)、脉搏氧饱和度(SPO2),记录两组患者辅用麻黄素、氟芬合剂的情况。结果CSA组麻醉前、后各时点的MBP、HR、SpO2均无显著性变化;EA组硬膜外用药后,MBP、HR明显下降(P<0.05)。从T0至T2时段,EA组有98%的患者需辅用麻黄素,显著高于CSA组(15%)(P<0.01),EA组麻黄素用量[(30.5±3.1)mg]显著高于CSA组[(4.1±0.5)mg](P<0.01)。EA组有40%的患者术中需辅用氟芬合剂,显著高于CSA组(15%)(P<0.05)。在T1、T2、T3各时点EA组动脉血乳酸浓度均高于CSA组(P<0.05)。CSA组术后未见连续腰麻相关并发症。结论与硬膜外麻醉相比,连续腰麻麻醉效果确切,对循环干扰小,非常实用于高危老年患者的下肢手术。

objective To investigate the effect of continuous spinal anesthesia applied in the elder with high ASA physical status undergoing lower extremity surgery. Methods Sixty-four ASA Ⅲ -Ⅳ patients aged 68～101 yr,scheduled for lower extremity surgery were randomly divided into epidural anesthesia group （EA, n=20）, continuous spinal anesthesia groups （CSA, n =20）.In group EA epidural block was performed. In group CSA, CSA was performed. Blood lactate was measured before anesthesia （T0, baseline）, when anesthesia level appeared （%）, lh after incision （T2）,when operation was over （T3）. ABP,HR,SpO2 were monitored. The dose of ephedrine and innovar used during anesthesia was recorded. Results The demographic data including sex,age, height,body weght, ASA physical status and types of operation were not significantly different between the two groups. MBP, HR were significantly decreased after anesthesia compared with the baseline values at TO in group EA;while there no significant changes in group CSA. The mean dose of ephedrine was significantly less in group CSA（4.1±0.5mg,administered to only 15% of patients） than in group EA（30.5±3.1mg, administered to 98% of patients）. Less patients received innovar during operation in group CSA （administered to 15% of patients） than those in group EA（administered to 40% of patients）. Blood lactate was significantly increased at T1,T2,T3 in group EA compared with group CSA.No complications related to continuous spinal anesthesia were observed in group CSA. Conclusion Continuous spinal anesthesia is safe, efficient, and provides better hemodynamic stability, better analgesia than epidural anesthesia in elderly patients.