老年硬膜外麻醉有关问题探讨

Evaluation of Epidural Anesthesia in Aged Patients

目的 :评价老年硬膜外麻醉的临床意义。方法 :310例老年患者在硬膜外麻醉下行手术治疗 ,其中高位 6例 ,中位 188例 ,低位 116例 ;对 30例术前血压、心率正常的病人麻醉前常规肌注麻黄碱 30mg。结果 :麻醉效果优良(镇痛完全、肌肉松驰 ) 2 82例 ,占 90 .97% ;麻醉效果欠佳 (镇痛不全或肌松不满意 ) 2 8例 ,占 9.0 3 % ;术中血压较术前下降超过 2 0 % 2 19例 ,占 70 .6 5 % ;2 80例麻醉前未用麻黄碱的病人术中血压较术前明显下降 2 15例 ,30例麻醉前肌注麻黄碱的病人 4例血压较术前明显下降 ;全组术中需用麻黄碱升压 171例 ,需用多巴胺升压 2 3例。结论 :老年硬膜外麻醉对循环功能抑制明显 ,易引起血压下降 ,麻醉前预防性使用麻黄碱有稳定循环功能的作用 ;老年硬膜外麻醉局麻药中以不加肾上腺素为宜 ,麻醉中应常规吸氧 。

Objective: To evaluate the clinical significance about epidural anesthesia in aged patients. Methods: 310 aged patients, ASA gradesⅡ～Ⅳ, underwent surgery by epidural block with 6 patients of puncture sopot above T 6, 188 patients of T 6～T 12, and 116 patients of lower T 12 .Thirty patients with normal blood pressure (BP) and heart rate were given ephedrine 30 mg by intramuscular injection before anesthesia. Results: The anesthetic effect in 282 patients (90.97%) was excellent while that in 28 patients was not good enough. BP of 219 patients (70.65%) was declined by 20% during operation than preoperative. 215 of 280 patients who were not given ephedrine before anesthesia showed a significant lower BP during operation than preoperative. While only 4 of 30 patients who were given ephedrine before anesthesia did a significant lower BP during operation than preoperative. There were 171 patients who needed ephedrine and 23 patients who need dopamine after anesthesia for raising BP. Conclusion: The epidural anesthesia could significantly repress the circulatory system and cause hypotension in senile patients. The administration of ephedrine before anesthesia could stabilize the circulatory system.