全麻复合硬膜外阻滞用于高龄患者腹腔镜直肠癌手术的观察

Observation on the Efficacy of General Anesthesia plus Epidural Block Anesthesia in Rectal Carcinoma Operation with Laparoscope in Senile Patients

为评价全麻复合硬膜外阻滞在高龄患者腹腔镜直肠癌根治术中对循环功能及用药量的影响，选择70岁以上择期行腹腔镜直肠癌根治术患者40例，ASAⅠ、Ⅱ级，随机分为全麻组（G组）20例；全麻复合硬膜外阻滞组（GA组）20例。两组全麻诱导方法：咪哒唑仑0．04mg／kg，芬太尼3μg／kg，依托咪酯0．2～0．3mg／kg，顺阿曲库胺0．15～0．20mg／kg。GA组于诱导前取L1-2硬膜外腔穿刺置管，注入0．5％罗哌卡因5ml。术中每2h追加5～7ml。诱导前以PhilipsMP40监测仪监测平均动脉压（MAP），心率（HR），心电图（ECG）等生命体征，同时记录全麻用药量及术中知晓、术后躁动情况。结果显示，GA组气腹后，气管插管拔除前MAP、HR明显低于G组（P〈0．05）；GA组七氟烷用药浓度，顺阿曲库胺用药量低于G组（P〈0．05）。结果表明，高龄患者在腹腔镜直肠癌根治术中应用全麻复合硬膜外阻滞，可使患者术中循环稳定，全麻用药量减少，是一种安全可行的麻醉方法。

The objective of the study was to observe the effect on the circulation function and drug dose of general anesthesia plus epidural block anesthesia（GA plus EBA） during rectal carcinoma operations with laparoscope in senile patients. Forty patients（above 70 years of age） with rectal carcinoma（ASA I , II grade） were randomized into two groups,20 cases underwent general anesthesia in the rectal carcinoma operations with laparoscope（group GA）,while another 20 cases underwent GA plus EBA （group GA plus EBA）. General anesthesia in the two groups was induced by： midazolam 0.04mg/kg, fentanyl 3μg/kg,eto-midate 0. 2-0.3mg/kg, eisatraeurium besilete 0. 15-0.20mg/kg. In lumbar vertebral~ 2 puncture intubation ropivacaine（0.5% ,5ml） was injected epidurally before induction and 5-7ml was added every 2 hours during operation. Before induction monitoring mean artery press（MAP）, heart rate（HR）, electoeardiogram（ECG） vital sign with Philips MP40 monitoring instrumnet,and at the same time recording the dosage of anesthetic general anesthesia ＆ introperative understanding, postoperative dysphoria state. As results, MAP, HR during the period of pneumoperitoneum and before tracheal extubation in group GA plus EBA was lower than in group GA（ P 〈0.05） and the sevoflurane and cisatracurium besilete dosage in the GA plus EBA group were lower too（ P 〈0.05）. It is concluded that application of GA plus EBA in the senile patients during rectal cancer operations with laparoscope can stabilize the circulation,reduce drug dose and is of a safe ＆ reliable anesthesia.