不同剂量脊麻药在老年患者前列腺电切术中的对比研究

The comparative research of different hyperbaric spinal anesthesia drug usages in elderly male patients' TUPKVP

目的对比研究不同剂量重比重脊麻药液用于经尿道等离子前列腺电切术中分别对老年男性患者生理机能的影响。方法择期行经尿道等离子前列腺电切术老年男性患者100例,随机分为A、B两组,脊麻穿刺成功后A组注入重比重脊麻液3ml,B组注入重比重脊麻液2ml。记录两组入室后、蛛网膜下隙给药后5min、蛛网膜下隙给药后10min、摆截石位后5min、出室时等共计5个时段的收缩压,舒张压,心率。记录两组蛛网膜下隙给药后15min时麻醉平面超过胸10患者例数,手术2h需硬膜外追加罗哌卡因患者例数,术毕后麻醉平面在术毕6h内完全消失的患者例数。结果 A组患者的血压及心率于蛛网膜下隙给药后5min、10min、摆截石位后5min下降非常明显,麻醉平面最高可达胸6(P<0.01);B组患者的血压及心率于蛛网膜下隙给药后10min、摆截石位后5min下降幅度远低于A组(P<0.05),余监测时段无明显变化,麻醉平面止于胸8,麻醉平面消失也快于A组(P<0.01)。结论脊麻时选择小剂量重比重脊麻药液能完全满足经尿道等离子前列腺手术的镇痛肌松等要求,且患者的血液动力学更为稳定,更安全可靠。

Objective To compare the respective influence of elderly male patients physiological function in transurethral resection of prostate with plasma kinetic（TUPKVP） by different dose hyperbaric spinal anesthesia drug usages.Methods To select 100 elderly male patients in TUPKVP and divide into A,B two groups randomly.After the success of spinal anesthesia puncture,to inject 3ml hyperbaric spinal anesthesia drugs to group A and 2ml to group B.To record two groups′ systolic blood pressure,diastolic blood pressure,heart rate of 5 times： entering operation room,5 minutes after subarachnoid space medicine injection,10 minutes after subarachnoid space medicine injection,5 minutes after lithotomy position,coming out from operation room.To record the patient number which anesthesia level more than chest 10 after subarachnoid space medicine injection 15 minutes,the patient number which in demand of epidural additional ROM after 2 hours surgery,the patients number of anesthesia level disappear completely in 6 hours after operation finished.Results The decline of patient′s blood pressure and heart rate from group A is very obvious in 5 minutes after subarachnoid space medicine injection,10 minutes after subarachnoid space medicine injection,5 minutes after lithotomy position,the level of anesthesia highest can amount to chest 6（P 0.01）.The decline range of patient′s blood pressure and heart rate from group B is far lower than group A（P 0.05） in 10 minutes after subarachnoid space medicine injection,5 minutes after lithotomy position,no obvious change in the other monitoring time,the level of anesthesia stopped at chest 8,the level of anesthesia also disappeared faster than group A（P 0.01）.Conclusion The small dose selection of hyperbaric spinal anesthesia drug can completely meet the analgesic muscle loose requirements of TUPKVP in spinal anesthesia,and will make patients blood dynamics more stable,more safe and reliable.