小容量高浓度罗哌卡因硬膜外阻滞复合全麻用于老年患者腹部外科手术

Epidural block with ropivacaine of small capacity and high concentrations combined with general anesthesia for elderly patients undergoing abdominal surgery

目的观察小容量高浓度罗哌卡因硬膜外阻滞复合全麻对老年患者腹部手术的影响。方法 60例ASAII～III级择期拟在全麻复合硬膜外麻醉下行腹部外科手术的老年患者,随机分为小容量高浓度组(H组)、小容量常浓度组(L组)和常规容量浓度组(C组)三组。手术开始前H组硬膜外推注0.75%的罗哌卡因针2～3 ml,L组推注0.25%的罗哌卡因针2～3 ml,C组推注0.25%的罗哌卡因针6～8 ml。以1%七氟烷针+丙泊酚针4 mg.kg-1.h-1微泵维持全麻,术中根据需要给予升压药或降压药稳定循环,必要时追加肌松剂。观察三组硬膜外穿刺点的选择和术中用药情况,三组呼吸恢复、清理和拔管时间。结果三组间硬膜外穿刺点选择比较,差异均无统计学意义(χ2分别=0.99、0.63、0.22,P均>0.05),术中应用苯肾上腺素患者数H组和L组明显低于C组,差异均有统计学意义(χ2分别=6.83、8.90,P均<0.05),关腹时H组需要追加肌松的患者数较L组和C组明显减少,差异均有统计学意义(χ2分别=6.53、3.91,P均<0.05);术毕H组自主呼吸恢复、拔除导管及完全清醒时间较L组和C组明显缩短,差异均有统计学意义(t分别=2.76、3.97、2.42;2.07、2.77、2.76,P均<0.05)。结论小剂量高浓度罗哌卡因硬膜外阻滞复合全麻用于老年高龄患者腹部手术,术中生命体征平稳,术毕苏醒迅速。

Objective To observe the effect of epidural block with ropivacaine of small capacity and high concentrations combined with general anesthesia that was used for elderly patients undergoing abdominal surgery. Methods Sixty elderly patients with ASA II-III undergoing abdominal surgery were randomly assigned into three groups： small capacity and high concentration group（H group）, small capacity and normal concentration group（L group） and normal capacity and concentration group （C group） . H group was given 0.75% of ropivacaine 2~3 ml in the epidural space, L group was given 0.25% of ropivacaine 2-3 ml and group C was given 0.25% of ropivacaine 6-8 ml at preoperation. Using 1% of seveflurine and propofol 4 mg· kg-1·h-1 micro-pump to maintain anesthesia. According to the the hemodynamic changes, the phenylephrine or ni, troglycerin was given duly, and the Rocuronium could be given if necessary. Results In the spinous process clearance of epidural puncture, there were no significant differences among the three groups （χ2=0.99,0.63,0.22,P〉0.05）.The number of patients used phenylephrine of group C was significantly more than that of group H and group L （χ2=6.83,8.90, P〈：0.05）. The number of patients needed to add rocuronium before closing abdomen of group H was significantly less than that of group L and group C （χ2=6.53,3.91 ,P〈0.05）. The time of spontaneous breathing recovery, pulling out the endotracheal tube and fully awake of group L and group C were significantly longer than that of the group H （t=2.76,3.97,2.42;2.07,2.77,2.76,P〈0,05）. Conclusions Epidural block with ropivacaine of small capacity and high concentrations combined with general anesthesia for elderly patients undergoing abdominal surgery has advantage of hemodynamics, and patients awaken quickly at postoperative.