不同方式全麻复合腰硬联合麻醉在高龄病人下肢骨科手术的应用

Application of Different Anesthesia with Combined Spinal-epidural for Lower Extremity Operation in very Old Patients

目的评估不同方式全麻复合腰硬联合麻醉在高龄病人下肢骨科手术中的应用价值。方法45例行下肢骨科手术的高龄病人患者,根据麻醉方法的不同将病人随机分为三组(n=15),组Ⅰ行气管插管控制呼吸全麻,组Ⅱ全麻+腰硬联合麻醉(CSEA),组Ⅲ全麻+CSEA,自主呼吸。观察不同麻醉方法的麻醉效应及对各组病人术后恢复的影响。结果全麻诱导后血压、心率下降(P<0.05),切皮时恢复麻醉前水平,各组间的变化差异无显著性。组Ⅱ、组Ⅲ舒芬太尼和异丙酚用量较组Ⅰ显著降低,术后清醒和气管拔管时间各组间差异显著(P<0.05)。结论不同方式全麻复合腰硬联合麻醉应用于高龄病人安全可靠,可减少全麻药物用量,使术后苏醒更为迅速。

Objective To evaluate the use of different anesthesia with combined spinal-epidural anesthesia （CESA） for lower extremity operation in very old patients. Methods forty-five old patients undergoing lower extremity operation were randomly divided into three groups. The group Ⅰ received general anesthesia,group Ⅱ and group Ⅲ used general anesthesia plus CESA, but no muscle relaxant were used for anesthesia maintenance in group Ⅲ. The time of awakening from anesthesia, and the extubation time were recorded. Results Blood pressure and heart rate decreased during induction, but there were no significant difference among three groups （ p〈 0.05）. The doses of sufentanil and propofol were decreased significantly in group Ⅱ and group Ⅲ than those in group Ⅰ. The time of awakening from anesthesia and the extubation time was less in group Ⅱ and group Ⅲ than those in group Ⅰ （p〈0.05）. Conclusion general anesthesia with CESA was safe and effective for old patient undergoing lower extremity operation. The patients received this technique could recover form anesthesia rapidly.