80岁以上高龄患者腹部手术两种麻醉方法的临床观察

Clinical Investigation of Two Anesthesia Methods in Elderly Patients above 80 Years Undergoing Abdominal Surgery

目的探讨两种麻醉方法对80岁以上高龄患者腹部手术的可行性。方法80岁以上高龄患者行腹部手术32例,随机分为两组:硬膜外麻醉联合全麻(观察组)和单纯全麻(对照组),每组16例。观察麻醉前、诱导期、插管期和拔管期的SP、DP、HR、SpO2及其临床资料。结果①与麻醉前比较,两组患者诱导期和插管期SP、DP、HR均有明显下降(P<0.01,P<0.05)。与对照组比较,观察组插管期的HR明显减慢(P<0.05)。两组麻醉后SpO2较麻醉前明显上升(P<0.01)。②两组丙泊酚、芬太尼、维库溴铵用量及拔管时间变化差异无统计学意义,观察组带管人数明显少于对照组(P<0.05)。③与对照组比较,观察组麻黄碱和阿托品使用人数明显增加;新福林和压宁定使用人数明显减少(P<0.05)。结论80岁以上高龄患者行腹部手术,采用硬膜外麻醉联合全麻或单纯全麻均安全有效;对麻醉中血流动力学变化关键是要有防范意识和处理手段;气管插管便于呼吸管理和供氧。

Objective To study feasibility of two anesthesia methods in elderly patients above 80 years old. Methods Total 32 elderly patients above 80 years were recruited and randomly divided into two groups, epidural blockade combined general anesthesia group （observation group, n = 16） and general anesthesia group（control group, n = 16）. SP,DP,HR,SpO2 and other clinical data were recorded in baseline, induction, endotracheal intubation and extubation time respectively. Results （1）In comparison with baseline value, SP,DP and HR were significantly decreased in anesthesia induction and intubation time in two groups （P 〈 0.01 ,P 〈 0.05）. In contrast with control group, HR significantly decreased in intubation time in observation group （P 〈 0. 05 ） . Compared to baseline values, SpO2 markedly increased after the initiation of anesthesia in two groups. （2）There was no statistical significance in the amount of propofol, fentanyl, vecuronium and extubation time between two groups, while the number of patients who need further respiration support was less in observation group than that of control group （P 〈 0. 05 ） . （3）In contrast with control group, the number of patients who administered ephpdrine and atropine prominently increased, however phenylephrine and urapidil markedly decreased （P 〈 0.05）. Conclusion It was safe and effective to adopt epidural blockade combined general anesthesia or general anesthesia in abdominal surgery in elderly patients above 80 years old. Prevention and appropriate treatment was crucial to cope with hemodynamic fluctuations during anesthesia, Endotracheal intubation was helpful to respiration administration and oxygen delivery.