小剂量罗哌卡因腰硬联合麻醉在老年病人经尿道前列腺电切术中应用

Application of combined spinal epidural anesthesia with low-dose ropivacaine in transurethral resection of the prostate in the aged

目的观察小剂量罗哌卡因腰硬联合麻醉在老年病人经尿道前列腺电切术中应用的可行性和血流动力学参数改变。方法选择40例择期行经尿道前列腺切除术病人,年龄65～85岁,ASAⅠ～Ⅲ级,腰硬联合穿刺,取L3～4蛛网膜下隙注入0.3%罗哌卡因混合液2 ml,然后向上置入硬膜外导管3 cm,术中酌情硬膜外注入1.73%碳酸利多卡因3～5 ml。观察感觉阻滞、运动阻滞和血流动力学参数变化。当收缩压(SBP)下降到90 mmHg或在原收缩压基础上下降30%时,静脉注射麻黄素5～10 mg,心率(HR)低于55次/min时,静脉注射阿托品0.3～0.5mg。结果40例麻醉效果皆满意,腰麻前后SBP、DBP和HR比较无显著性差异。3例手术时间延长病人术中硬膜外注入了碳酸利多卡因5 ml,其中1例静脉注射了麻黄素,2例静脉注射了阿托品。结论小剂量罗哌卡因腰硬联合麻醉在老年病人经尿道前列腺电切术中有良好的麻醉效果和稳定的血流动力学状态。

Objective To observe the effects of anesthesia and changes of hemodynamics produced by using lowdose ropivacaine in combined spinal epidural anesthesia in transurethral resection of prostate （TURP） in the elderly patients. Methods Forty ASA Ⅰ -Ⅲ patients, aged 65-85 years, undergoing elective TURP were involved. A puncture was performed at L3, 4 interspace for subarachnoid injection with ropivacaine 6 mg and then an epidural catheter was inserted 3 cm upward. The extent of sensation, motor blocking, and hemodynamics were recorded. When systolic blood pressure （SBP） was 〈 90 mmHg or decreased by 30% from baseline, intravenous ephedrine, 5-10 mg was given. When heart rate （HR） was 〈 55, atropine of 0. 3-0. 5 mg was given intravenously. Results All patients had a satisfactory anesthesia. SBP, DBP and HR did not change significantly after anesthesia （P 〉 0.05 ）. Lidocaine carbonate 3-5 ml was injected epidurally to 3 patients with prolonged operation, in addition, one of the three was given a single dose of 5 mg ephedrine, and another two a single dose of 0. 3 mg atropine, respectively. Conclusions A low dose of ropivacaine in combined spinal epidural anesthesia for transurethral resection of prostate in the aged may have a satisfactory anesthetic outcome and stable hemodynamics.