硬膜外阻滞复合全麻在老年病人开胸手术中的应用

GENERAL ANESTHESIA COMBINED WITH EPIDURAL BLOCK FOR ELDERLY PATIENTS WITH THORACTOMY

目的探讨一种更适合老年开胸手术的麻醉方法。②方法择期开胸手术病人８０例，随机分为４组（每组２０例），普鲁卡因静脉复合全麻组（Ｐ组）、芬太尼静脉复合全麻组（Ｆ组）、普鲁卡因复合全麻＋硬膜外阻滞组（ＥＰ组）、芬太尼复合全麻＋硬膜外阻滞组（ＥＦ组）。ＥＰ组及ＥＦ组在全麻诱导前先行胸椎Ｔ５～７间隙硬膜外穿刺置管行硬膜外阻滞。４组病人均采用静脉快速诱导气管内插管，机械通气，在上述麻醉的基础上间断吸入少量安氟醚及间断静脉注射潘库溴胺维持麻醉。术中持续监测血压、心电和脉搏血氧饱和度。③结果与Ｐ组及Ｆ组相比，ＥＰ组、ＥＦ组术中血液动力学较稳定（ｔ＝２．１３３～５．１９４，Ｐ＜０．０５，０．０１）；ＥＰ组及ＥＦ组全麻药用量较Ｐ组及Ｆ组明显减少（ｔ＝２．３０７～８．７７５，Ｐ＜０．０５，０．０１）；ＥＰ组、ＥＦ组自主呼吸恢复时间、拔管时间也较Ｐ组及Ｆ组短（ｔ＝２．７３１～３．８５６，Ｐ＜０．０１），清醒拔管例数较多（χ２＝５．１３～８．８８，Ｐ＜０．０５，０．０１），术中出现心律失常的例数较少。④结论硬膜外阻滞复合全麻比单纯全麻更有利于老年病人开胸手术，是一种安全、有效。

Objective To find out safer and more effective anesthesia method for elderly patients with thoractomy.Methods Eighty patients(aged from 65 to 82 yrs, ASA status 1—3) undergoing thoractomy were divided into four groups: Group P: general(GA) with 1% procaine+0.05% pethidine continuous iv; Group F: GA with fentanyl (bolus 0.1—0.2mg) intermittent iv. Group EP: group P+epidural anesthesia with 1% lidocaine+0.25% bupiracaine. Group EF: group F+epidural block with 1% lidocaine+0.25% bupivacaine. Groups EP and EF received epidural block (T5—7) before GA induction. All patients also received inhalation of enflurane and pancuronium for muscle relaxation. Results There were no significant changes in hemodynamic and heart rates in group EP and group EF. However in the other two groups, the hemodynamics were very unstable during operation(t=2.133—5.194, P<0.05, 0.01). Consumption of general anesthesia drugs in group EP and group EF was much lower than the other two groups (t=2.307—8.775,P<0. 05, 0. 01). The duration of recovery from GA was longer in group P or group F than the other two groups (t=2.731—3.856, P<0.01). Conclusion General anesthesia combined with epidural block were safe and effective methods providing very stable hemodynamics and heart rates for older patients undergoing thoractomy.