全身麻醉复合硬膜外阻滞在老年肺癌合并高血压病手术中的应用

Application of general anesthesia compounds epidural analgesia in pulmonary surgery of senile hypertension patient

目的探讨老年高血压病患者行肺癌手术的有效麻醉方法。方法择期行肺癌手术的老年高血压病患者32例，随机单盲分为单纯全身麻醉组16例和全身麻醉复合硬膜外阻滞组16例，监测2组患者术中血流动力学和心电图变化以及全身麻醉药用量和苏醒延迟发生率。结果单纯全身麻醉组出现明显的心血管反应，尤以插管及拔管前显著高于基础值，全身麻醉复合硬膜外阻滞组各时点血压和心率稳定，与单纯全身麻醉组比较心肌缺血有所改善，全身麻醉药用量少，无苏醒延迟发生。结论全身麻醉复合硬膜外阻滞可减轻应激反应，循环状态稳定，是老年高血压病患者行肺癌手术较为有效的麻醉方法。

Objective To research a better anesthesia method for pulmonary surgery of senile hypertension patients. Methods Thirty-two ASA Ⅰ-Ⅱ patients undergoing elective pulmonary surgery, were randomly assigned to be operated upon general anesthesia （n=16） and combined general and thoracic epidural anesthesia （n=16）. The： hemodynamic changes, ECG, dosage of anesthetic and rate of awakening delay were observed during operation. Results The singnificant cardiovascular reaction were observed In general anesthesia, especially after intubation and before extubation, In combined general and thoracic, epidural anesthesia, BP and HR were more stable during perioperation compared with general anesthesia, the dosage of anesthetic in combined general and thoracic epidural anesthesia was less than that in general anesthesia; myocardiac ischemia was improved and no awakening delay existed. Conclusion General anesthesia combined with epidural block can stabilize the hemodynamics and reduce the stress respones. It is the first choice for pulmonary surgery of senile hypertension patients.