硬膜外阻滞复合浅全麻用于老年高血压病患者开胸手术

Application of epidural analgesia compounds light general anesthesia in thoracic surgery of senile hypertension patient

目的观察硬膜外阻滞复合浅全麻对老年高血压患者开胸手术血流动力学变化、术中知晓及苏醒时间的影响。方法择期开胸手术的老年高血压患者60例，随机分为单纯全麻组（Ⅰ组）和浅全麻复合硬膜外阻滞组（Ⅱ组），监测两组患者术中的血流动力学变化和ECG的变化及全麻药用量和苏醒时间。结果Ⅰ组出现明显的心血管反应，尤以插管及拔管时显著高于基础值（P〈0．05），Ⅱ组各时点血流动力学稳定，与I组比较有显著差异（P〈0．05），心肌缺血有所改善，全麻药用量明显少于Ⅰ组（P〈0．01），术后清醒及气管拔管时间与Ⅰ组比较明显缩短（P〈0．01）。结论硬膜外阻滞复合浅全麻可减轻应激反应，循环状态稳定，全麻用药量减少，苏醒快，是老年高血压患者开胸手术的首选麻醉方法。

Objective To study the influenence of epidural analgesia compounds light general anesthesia on hemodynamic, intraoperative awareness and the revival time in thoracic surgery of senile hypertension patients. Methods Sixty ASA Ⅰ - Ⅱ patients undergoing elective thoracic surgery, were randomly assigned to be operated upon general anesthesia （group Ⅰ , n = 30） and combined light general anesthesia and thoracic epidural anesthesia （group Ⅱ ,n = 30）. The hemodynamie changes, ECG, dosage of anesthetic and revival time were observed during operation. Results The singnificant cardiovascular reaction were observed In group I , especially after intubation and before extubation （ P 〈 0. 05 ） , In group Ⅱ , BP and HR were more stable during perioperation compared with group Ⅰ （ P 〈 0. 05 ）. myocardiae ischemia was improved, the dosage of anesthetic in group ]I was less than that in group Ⅰ （ P 〈 0. 01 ） ; The revival time and the tracheal extubation time in group Ⅱ was shorter than the group Ⅰ （ P 〈 0. 01 ）. Conclusion Epidural analgesia compounds light general anesthesia can stabilize the hemodynamics and reduce the stress respones. It is the first choice for pulmonary surgery of senile hypertension patients.