全麻联合硬膜外麻醉用于老年腹部外科手术患者中的效果观察

Observation on the effect of general anesthesia combined with epidural anesthesia in the elderly patients undergoing abdominal surgery

目的探讨全麻联合硬膜外麻醉用于老年腹部外科手术患者中的麻醉效果。方法选取我院2015年1月~2017年1月期间收治的老年腹部外科手术患者84例,按照随机数字表法分为联合组42例与对照组42例。对照组采用全身麻醉,联合组在对照组基础上联合硬膜外麻醉。比较两组的麻醉效果、两组患者麻醉前及插管时、手术开始时、拔管时的SBP、HR的变化情况,以及两组患者的术后清醒时间、清醒程度评分。结果联合组的麻醉优良率95.2%,显著高于对照组的71.4%,组间比较差异具有统计学意义(P<0.05)。联合组与对照组麻醉前的HR、SBP比较无统计学差异,但联合组插管时、手术开始时、拨管时的SBP水平均显著低于麻醉前,且显著低于对照组,而对照组仅手术开始时SBP较其他时点显著降低,但插管时、手术开始时、拔管时的SBP始终高于联合组,组间比较差异有统计学意义(P<0.05)。联合组插管时、手术开始时的HR显著低于麻醉前及拔管时及对照组,对照组仅拔管时HR降低,联合组插管时、手术开始时、拨管时的HR明显高于对照组,组间比较差异有统计学意义(P<0.05)。联合组患者术后清醒时间快于对照组、清醒程度评分低于对照组,组间比较差异有统计学意义(P<0.05)。结论全麻联合硬膜外麻醉用于老年腹部外科手术能获得较好的麻醉效果,且对老年人循环系统的影响小,使得患者术毕及时清醒和早期拔管,对于提高手术成功率具有重要的临床作用。

Objective To investigate the anesthetic effect of general anesthesia combined with epidural anesthesia in elderly patients undergoing abdominal surgery. Methods 84 elderly patients undergoing abdominal surgery who were admitted to our hospital from January 2015 to January 2017 were selected. According to the random number table method, the patients were divided into the combined group of 42 cases and the control group of 42 cases. The control group was given general anesthesia, and the combined group was combined with epidural anesthesia on the basis of the control group. The anesthesia effect, changes of SBP and HR before anesthesia, upon intubation, at the beginning of the operation, and upon extubation were compared between the two groups, and the postoperative consciousness time and the score of consciousness degree were compared between the two groups. Results The excellent and good rate of anes- thesia was 95.2% in the combined group, which was significantly higher than that of 71.4% in the control group. There was statistically significant difference between the two groups （P〈0.05）. There was no statistically significant differences in HR and SBP between the combined group and the control group before anesthesia, but upon intubation, at the begin- ning of the operation, and upon extubation, the levels of SBP in the observation group were significantly lower than those before the anesthesia, and were significantly lower than those in the control group. SBP in the control group at the beginning of the surgery only was significantly lower than that at other time points.However,upon intubation, at the be- ginning of the surgery, and upon extubation, SBP was always higher than that in the combined group, and there was a statistically significant difference between the two groups （P〈0.05）.In the combined group, HR upon intubation and at the beginning of the surgery was significantly lower than that before anesthesia and upon extubation, and that in the control group. HR in the control group was lower only upon extubation. Upon intubation, at the beginning of the surgery, and upon extubation, HR was significantly higher than that in the control group,and there were statistically sig- nificant differences between the two groups（P〈0.05）. The consciousness time in the combined group was faster than that in the control group, and the score of consciousness degree was lower than that in the control group. There were statisti- cally significant differences between the two groups （P〈0.05）. Conclusion General anesthesia combined with epidural anesthesia for elderly abdominal surgery can get a better anesthetic effect,and the impact on the circulatory system for the elderly is small, so that the patients can become consciousness timely and take early extubation, which plays an important clinical effect for improving surgical success rate.