老年病人经尿道前列腺电切术中腰-硬联合麻醉应用

APPLICATION OF COMBINED SPINAL-EPIDURAL ANESTHESIA IN TRANSURETHRAL RESECTION OF THE PROSTATE IN THE AGED

目的观察小剂量丁哌卡因和芬太尼腰-硬联合麻醉在老年病人经尿道前列腺电切术中麻醉效果和血流动力学参数改变.方法选择40例择期行经尿道前列腺切除术病人,年龄65～86岁,ASA Ⅰ～Ⅲ级,腰-硬联合穿刺,取L3～4蛛网膜下隙注入丁哌卡因3 mg＋芬太尼20 μg混合液2 mL,然后向上置入硬膜外导管4 cm,术中酌情硬膜外注入17.3 g/L碳酸利多卡因2～4 mL.观察感觉阻滞、运动阻滞和血流动力学参数变化.当收缩压（SBp）下降到12.0 kPa或原收缩压30%以下时,静注麻黄素5～10 mg,心率（HR）低于55 min^-1时,静注阿托品0.3～0.5 mg.结果 40例麻醉效果皆满意,腰麻前后SBp、舒张压（DBp）和HR比较无显著性差异（P〉0.05）.3例改变了手术方式和1例手术时间延长病人术中硬膜外注入了碳酸利多卡因2～4 mL,其中2例静注了麻黄素,2例静注了阿托品.结论小剂量丁哌卡因和芬太尼腰-硬联合麻醉在老年病人经尿道前列腺电切术中有良好的麻醉效果和稳定的血流动力学状态.

Objective To observe the effect of anesthesia and changes of hemodynamics produced by using low-dose bupivacaine-fentanyl in combined spinal-epidural anesthesia in transurethral resection of prostate（TURP） in the elderly patients. Methods Forty ASA Ⅰ-Ⅲ patients, aged 65-86 years, underwent elective TURP were involved. A puncture was performed at L3-4 interspace for subarachnoid injection with bupivacaine 3 mg plus fentanyl 20 μg, and then an epidural catheter was inserted 4 cm upward. The extent of sensation, motor blocking, and hemodynamics were recorded. When systolic blood pressure （SBp） 〈12.0 kPa or decreased by 30% from baseline, intravenous ephedrine,5 10 mg, was given. When heart rate 〈55, atropine of 0.3- 0.5 mg was given intravenously. Results All patients had a satisfactory anesthesia. SBp, DBp and HR did not change significantly after anesthesia （P〉0.05）. Three patients converted to Open surgery and one prolonged, for whom, lidocaine carbonate 2-4 mL was injected epidurally, in addition, two of them was given a single dose of 5 mg ephedrine, and another two a single dose of 0.3 mg atropine. Conclusion A low dose of bupivacaine plus fentanyl in combined spinal-epidural anesthesia for transurethral resection of prostate in the aged may have a satisfactory anesthetic outcome and stable hemodynamics.