全麻复合硬膜外麻醉在老年患者腹腔镜胆囊切除术中的临床研究

The study of the general anesthesia combined with epidural anesthesia for aged patients who underwent laparoscopic cholecystectomy

目的探讨老年患者腹腔镜胆囊切除术用两种不同麻醉方法的临床效果。方法择期行腹腔镜胆囊切除术的老年患者80例(年龄>60岁),随机分为全麻组(A组)和全麻复合硬膜外麻醉组(B组),每组各40例。记录患者入室后(T1)、诱导后(T2)、插管后即刻(T3)、CO2气腹后(T4)及气管拔管后即刻(T5)各时点心率(HR)、收缩压(SBP)、舒张压(DBP)的变化;记录术毕患者苏醒时间、呼之睁眼时间和拔管时间;记录拔管后即刻、10 min、20 min、30 min伤口疼痛程度。结果B组与A组相比:B组在T3、T4、T5即刻的血流动力学较A组稳定,两组比较差异有统计学意义(P<0.05);其术后苏醒时间、呼之睁眼时间和拔管时间差异无统计学意义(P>0.05),但苏醒期间患者发生烦躁反应A组(13例)远高于B组(5例),差异有统计学意义(P<0.05);B组拔管后各时间点VAS评分明显低于A组(P<0.05)。结论老年患者LC实施全麻复合硬膜外麻醉,能减轻术中的应激反应,血流动力学稳定,减轻患者苏醒期疼痛,降低术后烦躁反应发生率,是老年患者较适宜的麻醉方法。

Objective To explore the effects of two different anesthesias for aged patients who underwent laparoscopic cholecystectomy.Methods80 aged patients（age60）who underwent laparoscopic cholecystectomy（LC）were randomly divided into general anesthsia group（group A）and general anesthesia combined with epidural anesthesia group（group B）,each group for 40 cases.The following data of two groups were recorded：the HR,SBP and DBP at the moment of entrance of surgery room（T1）,anesthesia induction（T2）,racheal intubation（T3）,establishment of pneumoperitoneum（T4）and extubation（T5）,the time of post-oeprative analepsia,the time of open eyes when arousal and extubation;the degree of pain in the minute of extubation,10 min,20 min and 30 min after extubation.ResultsGroup B compared with group A,the hemodynamics of B group was more stable in the instant of T3,T4,T5,the difference between two groups was sinificant（P0.05）;The time of analepsia,the time of open eyes when arousal and extubation was not sinificantly different between two groups（P0.05）.In group A（13 patients）had restlessness reaction,which was much more than B group（5 patients）.The VAS grade of group B at each time point after extubation was much less than group A（P0.05）.ConclusionGeneral anesthesia combined with epidural anesthesia for aged patients who underwent LC can lessen stress reaction during operation,stabilize hemodynamics,ease pain in the period of analepsia,decrease post-operative restlessness reaction,and more fit into the aged patients who underwent LC.