小剂量布比卡因腰硬联合麻醉在老年患者前列腺电切术中的应用

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

目的评价小剂量布比卡因腰硬联合麻醉用于老年患者经尿道前列腺电切术(TURP)的安全性和有效性。方法 60例择期行TURP术的老年患者,随机分为腰硬联合麻醉组(CSEA)组和硬膜外麻醉组(CEA)组,每组30例。观察并记录麻醉前和麻醉后5 min、10 min、15 min、30 min血压、心率、脉搏血氧饱和度,以及最高感觉阻滞平面、到达最高麻醉平面时间和麻醉效果及不良反应。结果 CSEA组麻醉效果好于CEA组(P<0.05),CSEA组有2例发生低血压,CEA组有7例,两组间差异有统计学意义(P<0.05)。最高感觉阻滞平面、心动过缓两组间差异无统计学意义。术中CEA组有3例发生恶心呕吐,两组间差异有统计学意义(P<0.01)。两组患者均无呼吸抑制、术后头痛发生。结论小剂量布比卡因腰硬联合麻醉可以安全、有效地用于老年患者TURP手术。

Objective To evaluate the clinical efficacy and safety of the low-dose bupivacaine with combined spinal and epidural anesthesia for transurethral resection of the prostate（TURP） in the aged.Methods Sixty aged patients with ASA II～III who underwent transurethral resection of the prostate were randomly divided into combined spinal-epidural anesthesia group（CSEA）and continuous epidural anesthesia（CEA） group of 30 patients each.BP,HR and SpO2 before anesthesia,5min,10min,15min,and 30min after intrathecal injection,the peak sensory block plane,the onset time of sensory block,the anesthesia effect and side-effect were recorded.Results The hemodynamic effect in CSEA group was better than that in CEA group（P0.05）.Low blood pressure occurred in 2 cases in CSEA group,and in 7 cases in CEA group（P0.05）.Nausea and vomiting occurred in 2 cases only in CEA group（P0.05）.No difference was detected in the peak sensory block plane and bradycardia between two groups（P0.05）.No respiratory depression or headache after operation was observed in either group.Conclusion The low-dose bupivacaine in combined spinal-epidural anesthesia is effective and safe for TURP in the aged.