全麻与硬膜外麻醉应用于老年冠心病患者肺叶切除手术的比较

Comparison between general anesthesia and epidural anesthesia for lung resection in elderly patients with coronary heart disease

目的比较全麻与硬膜外麻醉应用于老年冠心病患者肺叶切除手术的临床效果,更好地指导临床应用。方法选取2015年2月至2016年6月于我院进行肺叶切除手术伴有冠心病的老年患者60例,随机分为A,B两组,每组30人,A组行全身麻醉,B组行全麻复合硬膜外麻醉。观察比较两组患者麻醉不同阶段平均动脉压MAP、心率HR、血氧饱和度SpO_2、脑电双频指数BIS,测定麻醉时Ramsay镇静评分、VAS评分及两组患者手术时间、出血量及术后并发症发生率。结果 B组患者麻醉不同阶段MAP、HR、SpO_2及BIS值与B组相比更平稳,更接近于正常水平,疗效更持久(P<0.05);A组Ramsay镇静评分为(2.9±0.8)分显著低于B组(3.8±1.2)分(P<0.05);A组VAS疼痛评分为(3.7±1.3)分显著高于B组(1.6±0.8)分(P<0.05;两组患者手术时间、出血量及术后并发症发生率相比均不具有统计学意义(P>0.05)。结论全麻复合硬膜外麻醉应用于老年冠心病患者肺叶切除手术的临床效果较全麻好,值得在临床推广使用。

Objective To compare the clinical effect of general anesthesia and epidural anesthesia in elderly patients with coronary heart disease for lung resection to better guide clinical application.Methods From February 2015 to June 2016 in our hospital, 60 elderly patients with coronary heart disease were randomly divided into two groups, 30 cases in each group.The A group was under general anesthesia, and the B group received epidural anesthesia.The two groups were observed and compared respectively during different phases of anesthesia in mean arterial pressure, heart rate and oxygen saturation of MAP, HR, SpO2 and bispectral index BIS.Their anesthesia Ramsay sedation score, VAS score, operation time, bleeding volume and the incidence of postoperative complications were compared between the two groups.Results Compared with general anesthesia, epidural anesthesia had stable indexes closer to normal level and longer curative effect （P〈0.05）.The anesthesia Ramsay sedation score was obviously lower in the A group （2.9±0.8） than in the B group （3.8±1.2）, and the VAS score was higher in the A group （3.7±1.3） than in the B group （1.6±0.8） （P〈0.05）.Their operation time, bleeding volume and the incidence of postoperative complications showed no significant difference between the two groups （P〉0.05）.Conclusion Epidural anesthesia has better clinical effect than general anesthesia does for lung resection in elderly patients with coronary heart disease, which is worthy of widely clinical application.