全麻复合硬膜外阻滞用于老年慢性阻塞性肺疾病患者手术

Clinical Observation of General Anesthesia Combined Epidural Block on Old Patients with COPD

目的:探讨全麻复合硬膜外阻滞(GEA)用于COPD老年患者手术的可行性和安全性。方法:32例择期行上腹部和胸腔手术的老年患者随机均分为GEA组和单纯全麻(GA)组,术后分别采用硬膜外和静脉镇痛,记录手术时间、术后苏醒和拔除气管导管时间、术后镇痛效果(VRS评分)和术后呼吸系统事件,测定手术次日晨FVC、FEV_1/FC%、FEF_(25%～75%)。结果:术后苏醒和拔除气管导管时间GEA组较GA组明显缩短(P<0.05),术后镇痛GEA组明显优于GA组(P<0.05),呼吸系统事件的发生率GA组高于GEA组,手术次日晨测定FVC、FEV_1/FC%、FEF_(25%～75%)值GEA组与GA组存在明显差异(P<0.05),GEA组肺功能的恢复明显好于GA组。结论:全麻复合硬膜外阻滞可缩短苏醒时间和提高苏醒质量,术后镇痛完善,利于术后恢复,用于合并有COPD老年患者的手术是一种安全、有效、切实可行的麻醉方法。

Objective：To investigate the feasibility and safety of general anesthesia combined epidural block （GEA） on old patients with COPD. Methods：Thirty two patients scheduled for selective epigast or thoracic surgery were randomly divided into two groups, GEA group and GA group （general anesthesia）. Patient-controlled epidural analgesia and patient-controlled intravenous analgesia were used respectively after operation. Record surgery duration, waking time, extubation time, visual analgesia score and rate of incidence of respiratory system were recorded,FEVI/FC%,FEF25%～75% were measured in the morning the next day. Results： The waking time and extubation time of GEA group was significantly shorter than those in GA group （P〈0. 05）. The rate of the incidence of respiratory system was lower than that of GA group （P〈0. 05）. The effect of analgesia in GEA was more superior than that in GA group （P〈0. 05）, the recovery of pulmonary function was better in GEA group than that in GA group （P〈0.05）. Conclusion： General anesthesia combined epidural block in old patients with COPD is a safe, effective and feasible method which can decurtate the time of analepsia and improve quality of resuscitation, supply perfect analgesia and better postoperative recovery.