硬膜外阻滞对全麻下腹腔镜胃癌根治术老年患者苏醒期躁动的影响

Epidural block reduces emergence agitation after general anesthesia in elderly patients undergoing laproscopic gastric cancer eradication surgery

【摘要】目的观察硬膜外阻滞对全麻下腹腔镜胃癌根治术老年患者苏醒期躁动（EA）的影响。方法将择期腹腔镜胃癌根治术老年患者60例按随机数字表法分为硬膜外阻滞复合全麻组（Ⅰ组）和全麻组（Ⅱ组），每组30例。Ⅰ组在全麻诱导前行硬膜外穿刺，选择T8-9间隙，局麻药为0．25％罗哌卡因＋0．04mg／ml布托啡诺混合液，确定硬膜外麻醉有效后行全麻诱导，并在外科缝皮结束前10min硬膜外给予10ml局麻药后接患者自控硬膜外镇痛泵。Ⅱ组手术结束前10min给予芬太尼1μg／kg，同时接患者自控静脉镇痛泵术后镇痛。记录两组患者全麻药用量和拔管时间，记录患者入麻醉后恢复室时的躁动评分（RS）。结果Ⅰ组RS评分明显低于Ⅱ组，Ⅱ组有17例RS评分≥2分，而1组仅6例，其中重度EAI组仅1例，而Ⅱ组有7例（P〈0．05）。Ⅰ组瑞芬太尼用量、七氟烷用量和拔管时间分别为（580±20）ug、（145±13）mI和（5．6±1．1）min，明显低于B组[（951±29）ug、（382±52）ml、（12．8±32）min]（均P〈0.05）、结论硬膜外阻滞复合全麻可以明显降低全麻下腹腔镜胃癌根治术老年患者麻醉后EA的发生，有利于患者的康复。

Objective To investigate the effects of epidural block on emergence agitation（EA） in elderly patients undergo- ing laproscopic gastric cancer eradication surgery. Methods Sixty ASA Ⅰ or Ⅱ patients, aged 65-75y scheduled for laproscopic gastric cancer eradication surgery were randomized to receive either epidural combined with general anesthesia （group Ⅰ, n=30 ） or general anesthesia （group Ⅱ ,n=30 ）. Thoracic 8-9 vertebral clearance for puncture and epidural catheter was placed before general anesthesia in group I . A test dose of 4ml 0.25% ropivacaine combined with 0.04mg/ml butorphanol was given. When correct positioning of the epidural catheter was confirmed, general anesthesia was induced with midazolam 0.03mg/kg, propofol 1-1.5mg/kg, fentanyl 3-4μg/kg and rocurium 0.9mg/kg. Anesthesia was maintained with pumping remifenfanyl 0.15- 0.25μg· kg·-1min· and inhalation sevoflurane. In group II, patients received the same general anesthesia as group I . Patients in group I received 10ml 0.25% ropivacaine combined with 0.04mg/ml butorphanol epidural before the end of operation and patients con- trolled epidural analgesia （PCEA） .Patients of group Ⅱ received 1.0μg/kg fentanyl intravenously before the end of operation and patients controlled intravenous analgesia （PCIA）. The restlessness score （RS）, extubation time, general anesthesia dosage were recorded. Results In group Ⅰ , the mean score of RS was 19 while the group Ⅱ was 52, the EA was 6 while the group Ⅱ was 17. Time of extubation of group I was shorter than that of group Ⅱ （5.6 min vs.12.8min）. Seven patients in group Ⅱ developed seri- ously EA whereas only 1 patient in group Ⅰ（P〈0.05）. Conclusion Epidural block significantly reduces agitation during emergence of general anesthesis in elderly patients undergoing laproscopic gastric cancer eradication surgery.