高龄患者前列腺电切术不同麻醉方法的比较

Comparison of different anesthesia for transurethral resection of the prostate of old patients

目的比较腰硬联合阻滞与硬膜外阻滞麻醉在高龄前列腺电切术中的临床效果。方法 60例择期行经尿道前列腺汽化电切术的前列腺增生肥大的患者,随机分为2组各30例,Ⅰ组:L2～3腰硬联合阻滞麻醉,腰麻药:2%盐酸罗哌卡因1.5 mL;Ⅱ组L2～3连续硬膜外阻滞麻醉,硬膜外用药:1.33%利多卡因10 mL+0.33%地卡因5 mL+1/10 000肾上腺素,2组均硬膜外置管术后镇痛。记录患者不同时点的心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2)及其他相关数据。结果Ⅱ组患者T3时的平均动脉压、心率低于Ⅰ组,差异有统计学意义(P<0.05);Ⅱ组麻醉效果优的患者个数明显低于Ⅰ组,差异有统计学意义(P<0.05)。结论腰硬联合阻滞麻醉应用于高龄前列腺电切术麻醉效果确切,对患者呼吸、循环影响小,是一种较佳的麻醉方法。

Objective To observe the effect of combined spinal-epidural anesthesia and epidural anesthesia for transurethral resection of the prostate of old patients. Methods Sixty scheduled for transurethral resection of the prostate surgery patients（70-85y） were randomly assigned to 2 groups, Group I ： combined spinal-epidural anesthesia （L2-3）, 2% ropivacaine 1.5ml. Group II ： epidural anesthesia （L2-3）, 1.33% lidocaine and 0.33 tetracaine and 1/10000adrenaline. Block level was controlled under T10. HR,MAP,SpO2 were recorded at different times and effect of anesthesia and side effect were also recorded. Results MAP and HR of Group I1 were obviously lower than Group I at T3 （P〈0.05）, number of patients obtained good anesthesia effect of Group ]l was obviously lower than Group I （P〈0.05）. Conclusion Combined spinal-epidural anesthesia is effective for old patients undergoing transurethral resection of the prostate with little influence to respiration and circulation