高龄患者腹腔镜胆囊切除术不同麻醉方法的比较

The comparison of different anesthesia methods in elderly patients undergoing laparoscopic cholecystectomy

目的观察比较3种麻醉方法对高龄LC患者的呼吸循环功能和麻醉效果的影响。方法60例高龄LC患者随机分成3组，每组20例。EA组，连续硬膜外阻滞麻醉组；GA组，静吸复合全身麻醉组；EGA组，小剂量硬膜外阻滞复合静吸全身麻醉组。观察3组麻醉开始前（T0）、麻醉诱导期（T1）、气管插管时（T2）、拔除气管导管时（B）HR、SBP、DBP、MAP、PETCO2、ECG，GA组与EGA组同时监测异氟醚MAC、气道压、手术结束自主呼吸恢复时间、自主呼吸潮气量达标、拔管时间、肌松情况及患者麻醉苏醒时间。结果EA组有17例麻醉效果优良，SpO2〉95％，PETCO2维持在正常范围，EGA组术毕自主呼吸恢复时间明显短于GA组（P〈0．01），EGA组潮气量达标拔管时间明显短于GA组（P〈0．01），EA组在麻醉10～15min后血压下降程度与GA组、EGA组麻醉诱导期血压下降相似（P〉0．05），EGA组在气管插管／拔管期血压波动不明显，而GA组血压显著升高（P〈0．01），EA组与GA组麻醉效果相似，EGA组麻醉效果优于GA组（P〉0．05）。结论EGA组麻醉椎管内局麻药用量、全麻维持药用量、肌松药用量等均相应减少，呼吸循坏功能较为稳定，术毕麻醉苏醒快，自主呼吸恢复和潮气量达标迅速，多数患者术毕即可拔出气管导管，是高龄LC手术患者理想的麻醉选择。

Objective To observe and compare the influence of respiration, circulation and the effect of anesthesia in three anesthetic methods for the elderly patients undergoing LC.Methods 60 cases of elderly patients were randomly divided into three groups： EA Group, continuous epidural anesthesia; GA groups, inhalation-general anesthesia, EGA group, small dose of epidural anesthesia combined with inhalation general anesthesia. Observe HR, SBP, DBP, MAP, PETCO2, ECG of the three groups before the start of anesthesia （T0） ,anesthesia indnction period（ T1 ）, tracheal intubation（T2） and extubation （ T3 ）. Isoflurance MAC, airway pressure, recovery time to breathe independently,the time for tidal volume target and time for extuation,muscle relaxants were monitored in GA and EGA group. Results 17 cases in EA group attained fine effect, SpO2 〉 95 %, PETCO2 maintained in the normal range.The recovery time in EGA group to breathe independently, the time for tidal volume to standards and tubation was shorter than in GA group （ P 〈 0.01） .Decline degree in blood pressure in EA group 10- 15minutes after anesthesia was similar to GA group and EGA group（ P 〉 0.05）.Blood pressure in EGA did not fluctuate obviously, but was significantly higher in GA group in the period of endotracheal intubation/extubation（ P 〈 0.01） .Effects were similar in EA and GA group, however, more excellent in EGA group（ P 〉 0.05）. Conclusion In EGA group, the dosage of spinal anesthesia, maintenance of GA, and muscle relaxant was decreased. Circulation was more stable. It is rapid to recover breath independently and tidal volume reached to standard faster. Tracheal tube could be pulled out in the majority of patients. In all, EGA was an ideal choice of anesthesia for elderly patients undergoing LC.