硬膜外麻醉与腰-硬联合麻醉用于老年患者下肢手术的比较

Comparison of Combined Spinal- epidural Anesthesia with Epidural Anesthesia in Elderly Patients with Lower Extremity Surgery

目的观察腰硬联合麻醉用于老年患者下肢手术的效果及安全性,并与单纯连续硬膜外麻醉进行比较。方法100例行下肢手术的老年患者ASA分级Ⅱ～Ⅲ级,随机分为单纯硬膜外阻滞组(EA组,n=50),腰麻-硬膜外联合阻滞组(CSEA组,n=50)。分别测定椎管内注药前,椎管内注药后5min、10min、30min、60min、90min以及术毕共7个时点的SBP、DBP、MAP、HR、SPO2,麻醉后测定麻醉的起效时间及阻滞完全时间,并统计术中及术后发生恶心、呕吐的例数,术后头痛的例数,及局麻药的总用药量。结果两组患者注药后血压、心率变化无明显差异。CSEA组患者麻醉起效时间及阻滞完全时间明显快于EA组(P<0.01或P<0.05)。罗哌卡因及利多卡因用量CSEA组明显少于EA组(P<0.01)。术中恶心、呕吐者CSEA组6例,EA组2例;两组术后均无头痛发生。结论CSEA较单纯硬膜外麻醉提供了更好的感觉和运动神经阻滞,血流动力学平稳,患者的舒适程度明显提高,是老年患者下肢手术的较好的麻醉方法。

Objective To observe efficacy and safety of the combined spinal-epidural anesthesia and continuous epidural anesthesia for lower limb surgery in elderly patients and compare the former with the latter. Methods One hundred elderly patients with lower extremity surgery, ASA grade Ⅱ-Ⅲ were randomly divided into epidural anesthesia group（EA group, n = 50）, combined spinal-epidural anesthesia group （CSEA group,n = 50）. SBP,DBP,MAP,HR and SPO2 were measured before injection of intraspinal injection and after 5min, 10min,30min, 60min, 90min of intraspinal injection until the operation completion. Local anesthetic onset time and sensory nerve complete block time, nausea and vomiting, headache rate and total dosage of local anesthetics also were measured. Results Blood pressure and heart rate showed no significant difference after local anesthetics injection in two groups. Anesthetic onset time and sensory nerve block time in CSEA group was signif- icantly faster compared with the EA group（P〈 0.01 or P〈 0.05 ）. The total dosage of Ropivacaine and Lidocaine in CSEA group was signifi- cantly less than that of EA group（P 〈 0.01 ）. Nausea and vomiting of CSEA group has six cases and EA group has two eases during operation, and there was no headache in two groups. Conclusion CSEA could provide better muscle relaxation and nerve block,with more comfortable degree and better safety.lt is a good anesthetic method for lower limb surgery in elderly patients.