硬膜外麻醉与全身麻醉用于高龄患者骨科下肢手术的比较研究

The clinical comparison of epidural anesthesia and general anesthesia in elderly patients undergoing lower extremity surgery

目的比较连续硬膜外麻醉与全身麻醉用于高龄患者骨科下肢手术的麻醉效果和术后恢复情况。方法 212例择期手术的老年患者,男100例,女112例,年龄75～106岁,ASAⅡ～Ⅲ级,将患者随机分为硬膜外麻醉组(EA组)和全麻组(GA组),每组106例。EA组静脉输注多巴胺1～2μg/(kg.min)同时实施连续硬膜外麻醉,穿刺成功后注入2%利多卡因,调节麻醉平面<T10,根据患者情况硬膜外单次注入或连续输注2%利多卡因3～5ml/h,调节多巴胺用量。GA组常规全麻诱导气管插管,七氟烷-丙泊酚静吸复合全麻维持,术中根据循环调节血管活性药物,术毕带气管插管返回ICU监护。观察两组的血流动力学(入室、麻醉后、切皮、手术1h、术毕),血气分析(术前、麻醉后、手术1h、术毕),术后恢复时间(清醒可遵嘱活动),术后并发症和镇痛效果。结果 EA组术中的血流动力学比GA组稳定(P<0.05),GA组麻醉后及术中血气分析PaO2显著高于EA组,PaCO2显著低于EA组(P<0.05)。EA组术后恢复及镇痛效果较GA组好,术后并发症少。结论连续硬膜外麻醉用于高龄患者下肢手术麻醉效果满意,血流动力学较全麻更为平稳,术后恢复更快,镇痛效果好,更适合于医疗资源有限的基层医院,值得在临床推广。

Objective To compare the effect of continuous epidural anesthesia and general anesthesia on the prog- nosis of elderly patients undergoing lower extremity surgery. Methods 212 cases of ASA Ⅱ -Ⅲ elective surgery elderly patients were included. 100 cases were male and 112 cases were female. Their age ranged from 75-106 years old. All these patients were randomly divided into the epidural anesthesia group （EA group） and the general anesthesia group （GA group）. EA group received continuous epidural anesthesia with continuous intra-venous infusion of dopamine 1-2 μg/（kg-min）, 2% lidocaine was injected after the success of lumbar puncture procedure, and the anesthesia plane was carefully adjusted to below T10. Then bolus injection or continuous infusion of 2% lidocaine 3-5 ml/h were given based on patient＇s situation and the dosage of dopamine was adjusted. GA group received conventional induction, seven fluo- rine-propofol compound was used for anesthesia maintenance. After operation, patients were sent to ICU with tracheal in- tubation. Observation of hemodynamics, blood gas analysis, recovery time after surgery, postoperative complications, and analgesic effects were recorded. Results The hemodynamies of EA group was more stable than GA Group （P 〈 0.05）. The PaO2 of the GA Group after anesthesia induction and intra-operative was significantly higher than the EA Group. The Pa- CO2 of the GA group was lower than the EA Group （P 〈 0.05）. The postoperative analgesia and recovery time of the EA group was better than the GA group. Conclusions Continuous epidural anesthesia in elderly patients undergoing lower extremity surgery is more stable, has faster postoperative recovery and analgesic effects. The cost is low and more applica- ble for small size hospitals.