不同浓度小剂量利多卡因腰硬联合麻醉在老年肛肠疾病患者非PPH中的临床效果观察

Observation on effect of different concentrations and small dose of lidocaine of CSEA in elderly patients with non-PPH anorectal surgery

目的观察不同浓度小剂量利多卡因腰硬联合麻醉在老年患者肛肠疾病非吻合器痔上黏膜切除术(PPH)中的临床效果。方法选择该院2013-2014年行非PPH肛肠疾病患者120例为研究对象,分为A组(1.5%利多卡因)、B组(1.0%利多卡因)、C组(0.8%利多卡因)和D组,每组30例。A组、B组、C组腰硬联合麻醉,D组采用骶管麻醉。观察患者不同时间点心率(HR)、平均动脉压(MAP)变化及手术前后应激反应情况,记录麻醉操作时间、起效时间、术后恢复活动时间、麻醉效果评级、成功率、术后患者满意度、术者满意度和尿潴留情况。结果 4组患者不同时点MAP、HR比较,差异无统计学意义(P>0.05)。A组、B组、C组患者麻醉起效时间、术后恢复活动时间均明显少于D组(P<0.01),A组术后恢复活动时间长于B组和C组。A组、B组、C组尿潴留患者明显少于D组(P<0.05)。A组、B组患者满意度、术者满意度均为100%。结论 1.0%利多卡因腰硬联合麻醉更适合于高龄肛肠疾病患者非PPH。

Objective To evaluate the efficacy of different concentrations and small dose of lidocaine of combined spinal epidural anesthesia（CSEA）in elderly patients with non-procedure for prolapse and haemorrhoids（PPH）anorectal surgery.MethodsOne hundred and twenty elderly patients undergoing non-PPH anorectal surgery were selected and randomly dividedin to 4 groups,the group A（1.5%lidocaine）,B（1.0%lidocaine）,C（0.8%lidocaine）and D,30 cases in each group.The group A,B and C adopted CSEA,and the group D adopted the sacral anesthesia.The changes of mean arterial pressure（MAP）and heart rate（HR）at different time points,stress reactions before and after operation,anesthetic operating time,effect onset time,postoperative reactivating time,anesthetic grade,success rate,postoperative patient satisfaction,postoperative surgeon satisfaction and urine retention were recorded.Results MAP and HR at different time points had no statistical difference among 4 groups（P〈0.05）.The anesthetic onset time and postoperative activity recovery time in the group A,B and C were significantly less than those in the group D（P〈0.01）.The postoperative activity recovery time in the group A was longer than that in the group B and C.The urine retention time in the group A,B and C was significantly less than that in the group D（P〈0.05）.The postoperative patient satisfaction and surgeon satisfaction in the group A and B were 100%.Conclusion 1%lidocaine CSEA is more suitable for the elderly patients with non-PPH anorectal operation.