腰硬联合静脉全麻用于腹腔镜下老年腹会阴切除术

Application of Combined Spinal Epidural Anesthesia in Laparoscopic Abdominoperineal Resection for elderly Patients

目的:探讨腰麻-硬膜外联合阻滞复合静脉全麻在老年高血压患者腹腔镜下提肛肌腹会阴切除术的应用。方法:选取老年高血压低位直肠癌患者40例,根据麻醉方法分为对照组(静脉全身麻醉)与观察组(腰硬联合静脉全麻),每组各20例,记录两组麻醉诱导前(T_0)、麻醉诱导后2 min(T_1)、二氧化碳气腹后10 min(T_2)、气腹后30 min(T_3)及麻醉苏醒拔管后10 min(T_4)的平均动脉压(MAP)、心率(HR)变化,记录静脉麻醉药和肌松药总用量,观察术终苏醒时间及表现。对数据进行统计学处理。结果:两组患者手术麻醉过程均平稳,术毕复苏后直接回病房,无麻醉后并发症。两组患者的MAP、HR除T_0、T_1差异无统计学意义(P>0.05)外,其余各时间点观察组的MAP、HR显著低于对照组(P<0.05);两组内T_0时的MAP、HR与其余时间点相比均明显降低(P<0.05)。观察组患者术后苏醒时间和拔管时间分别为(13.6±3.6)min、(15.0±4.2)min,均显著短于对照组[分别为(16.3±4.8)min、(19.5±5.3)min];观察组术后躁动发生例数(1/20)也显著少于对照组(7/20),观察组全麻维持的静脉麻醉药和肌松药的总量[丙泊酚(680±155)mg、舒芬太尼(29.8±4.7)μg、瑞芬太尼(1.1±0.2)mg、顺式阿曲库铵(26.5±5.5)mg]显著低于对照组[丙泊酚(1150±195)mg、舒芬太尼(47.5±6.5)μg、瑞芬太尼(1.5±0.4)mg、顺式阿曲库铵(40.6±6.4)mg,P值均小于0.05]。结论:腰麻-硬膜外联合阻滞复合静脉全麻用于老年高血压患者腹腔镜下行提肛肌腹会阴切除术可获得满意肌松和镇痛效果。

ObjectiveTo explore the application of spinal epidural anesthesia combined with intravenousanesthesia in elderly hypertension patients undergoing laparoscopic extralevator abdominoperineal excision.MethodsTotal 40 elderly hypertensive patients with low rectal carcinoma were divided into control group（withintravenous general anesthesia） and observation group（using spinal epidural anesthesia combined with intrave-nous anesthesia group）, 20 cases in each group. The mean arterial pressure（MAP）, heart rate（HR） changeswere monitored and recorded in two groups before induction of anesthesia（T0）, 2 min after induction of anesthesia（T1）,carbon dioxide pneumoperitoneum after 10 min（T2）, carbon dioxide pneumoperitoneum after 30 min（T3）and anesthesia 10 min after exudation（T4）. The postoperative recovery time and recovery quality and the totalamount of anesthetics were recorded.ResultsThe patients in two groups were stable during anesthesia. Therewere no obvious postoperative complications after anesthesia. The changes of MAP and HR in the observationgroup were significantly lower than that in control group at the time points of T2, T3 and T4（P〈0.05）. Postop-erative recovery time and extubation time in observation group were [（13.6±3.6） min and（15.0±4.2） min], respec-tively, significantly less than that in control group [（16.3±4.8） min,（19.5±5.3） min]. Postoperative agitation in ob-servation group（1/20） was less occurred than that in control group（7/20）. The total amount of anesthetics and mus-cle relaxant in observation group was much less than that in control group.ConclusionSpinal epidural anes-thesia combined with intravenous anesthesia had satisfactory relaxation and analgesia in eldly hypertension pa-tients undergoing laparoscopic abdominoperineal resection.