腰麻-硬膜外联合麻醉用于高龄患者TURP布比卡因剂量的研究

Dosage of Combined Spinal-epidural Anesthesia with Levobupivacaine in the Elderly Undergoing TURP Surgery

目的比较三种剂量左旋布比卡因用于老年人尿道前列腺电切术(TURP)手术时腰麻-硬膜外联合麻醉的临床效应。方法60例老年患者在腰麻-硬膜外联合麻醉下行TURP。按所用左旋布比卡因剂量不同随机分为三组,每组20例。Ⅰ组用5 mg,Ⅱ组7.5 mg,Ⅲ组10 mg。观察感觉阻滞平面、运动阻滞程度、麻醉效应和不良反应。结果三组最高感觉阻滞平面和到达时间差异无显著性意义,Ⅰ组运动阻滞程度Bromage分级明显低于其他两组(P<0.05)。20 min腰麻最高阻滞平面和平面至T10时硬膜外2%利多卡因用量三组间比较差异有统计学意义(P<0.01)。Ⅰ组麻醉效果较Ⅱ组、Ⅲ组差(P<0.01),但Ⅲ组麻醉中低血压发生率多于其他两组(P<0.05)。结论左旋布比卡因7.5 mg用于腰麻-硬膜外联合麻醉在老年人TURP中使用,可以达到比较安全而全面完善的麻醉效果。

Objective To compare three different dosage of levobupivacaine used for combined spinal- epidural anesthesia in the elderly undergoing transurethral resection of the prostate （TURP）. Methods sixty patient scheduled for TURP were divided into three groups with 20 cases in each group, levobupivacaine 7mg was use in group Ⅰ, levobupivacaine 7.5mg in group Ⅱ ,and levobupivacaine 10mg in group Ⅲ. The anesthetic effect on sensory and motor blockade, incidence of hypotension and bradycardia, quality of intraoperative analgesia and occurrence of neurological complications within 28 hours postoperatively were compared. Results The intensity of motor blockade evaluated with evaluated with bromage scale in group Ⅰ was lower than that in group Ⅱ and group Ⅲ. No obvious neurological complications were found in three group. The rate of hypotension in group Ⅲ was more than other two group. Conclusion Combined spinal - epidural anesthesia with levobupivacaine 7. 5mg is safe and sufficient in elderly undergoing transurethral resection of the prostate.