老年急性肠梗阻病人的麻醉探讨

An Investigation on Anesthesia Methods in Acute Ileus Surgery of the Eldly

目的比较两种麻醉方法硬膜外复合全身麻醉(GE组)和单纯全麻(G组)在老年急性肠梗阻病人术中的应用,指导临床实践。方法本实验选择老年急性肠梗阻病人36例,分为硬膜外复合全身麻醉(GE组)和单纯全麻(G组),每组18例,GE组病人先进行硬膜外穿刺(T10-11),给于2%利多卡因5 ml,测定有效的麻醉平面后,开始常规诱导。两组病人均以芬太尼、维库溴铵、咪唑安定、异丙酚静脉诱导,麻醉维持以持续吸入异氟醚为主,G组辅以单次静注维库溴铵2-4 mg,芬太尼0.05-0.1 mg,GE组术中每1 h硬膜外腔追加0.5%布比卡因5 ml。观测诱导前、插管2 min、探查时、关腹时的SBP、DBP、HR、SPO2,记录催醒药和肌松拮抗药例数和拔管时间。结果插管2 min、探查时,GE组SBP、DBP均比诱导前显著降低(P<0.05),G组SBP、DBP均比诱导前显著升高(P<0.05),两组间比较,GE组SBP、DBP均比G组显著降低(P<0.01),除插管2min时,HR较明显升高外,两组病人各时点的HR、SpO2变化不明显。GE使用催醒药和肌松拮抗药例数明显减少,拔管时间明显缩短。结论硬膜外复合全身麻醉比单纯全麻应激反应小,清醒快,拔管早,不失为老年人急性肠梗阻病人的最佳选择。

Objective To compare the effect of general anesthesia combined with epidural block and with general anesthesia only in acute ileus surgery of the eldly, and to bulid a guideline for clinical use.Methods Thirty-six eld patients undergoing acute ileus surgery were randomly divided into two groups that went with eneral anesthesia combined with epidural block （Group GE） and general anesthesia （Group G） separately with 18 cases in each group. In Group GE,patients firstly got epidural puncturation in T10-11 and lidocaine with concentration of 2% was administrated. When the block became valid,routine induction was carried out with fentanyl, vecuronium,midazolarn and propofol, and isoflurane was administrated for the maintainence, which was also performed in Coup G in the same way. In Group G,vecuronium 2- 4 nag and fentanyl 0.05 - 0.1 nag were administrated when necessary and 5 ml 0.5% bupivacaine was administrated once every hour.The observed items are SBP, DBP, HR, SPO2, the number of cases that were given analeptics and muscle relaxant antagonistic drugs and extubation time in preinduction,2 minutes postintubation, surgical exploration and shutting the abdomen. Results SBP and DBP in Group G increased significantly （ P 〈 0.05） 2 minutes preintubafion and when the expomfion was going on, whereas in Group GE, compared with Group G, SBP and DBP didn＇ t change much. There was no variation of HR and SPO2 in both groups except 2 minutes preintubation.There are less eases in Group GE than in Group G that were given analepties and muscle relaxant antagonistic drugs and the extubation time is much shorter. Conclusion general anesthesia combined with epidural block is better than general anesthesia in acute ileus surgery of the eldly for its less stress reaction, swifter recovery of conciousness and earlier extubation.