全身麻醉与脊髓麻醉对老年日间输尿管镜碎石术后苏醒及出院时间的影响研究

Influence of spinal anesthesia and general anesthesia on postoperative recovery and discharge time among geriatric patients with day surgery of ureteroscopic lithotripsy

目的探讨全身麻醉与脊髓麻醉对老年患者日间输尿管镜碎石术后苏醒及出院时间的影响。方法选取2019年1月至2019年12月在本院行日间输尿管镜碎石术的60例年龄≥65岁的患者,所有患者的美国麻醉医师协会(ASA)评级为Ⅱ~Ⅲ级。将患者随机分为两组,一组设为全身麻醉组(30例),另一组设为脊髓麻醉组(30例)。全身麻醉组患者采用瑞芬太尼1μg/kg、丙泊酚2 mg/kg缓慢静脉注射诱导麻醉,待睫毛反射消失后,置入适型喉罩,患者吸入含60%氧化亚氮的氧气的同时,注射氟烷(呼气4%)维持麻醉状态;脊髓麻醉组患者以坐位接受脊髓麻醉,将5 mg 0.5%布比卡因注射至第4腰椎椎体至第5腰椎椎体椎间隙。记录两组患者的手术时间、麻醉准备时间、手术室麻醉相关时间、麻醉快速苏醒时间、恢复室(PACU)停留时间、坐立时间、下床活动时间及出院时间。由手术室麻醉医生评估患者的心功能参数、恶心/呕吐发生情况,由外科医生及患者评估麻醉的满意度、围手术期咪达唑仑-芬太尼使用情况及术后疼痛情况。结果全身麻醉组的麻醉准确时间、手术时间、手术室麻醉相关时间、患者开始坐立时间、开始下床活动时间均少于脊髓麻醉组(P<0.05),而苏醒时间、出院时间均高于脊髓麻醉组(P<0.05)。全身麻醉组患者的麻醉诱导时及诱导1、3、5、10和30 min后的血压和心率均明显低于脊髓麻醉组(P<0.05),而SpO2高于脊髓麻醉组(P<0.05)。两组患者对麻醉的满意度、围手术期咪达唑仑-芬太尼使用情况及术后疼痛情况比较,差异均无统计学意义(P>0.05)。结论脊髓麻醉是行日间输尿管镜碎石术治疗的老年患者中一种安全有效的麻醉方法。

Objective To compare the effect of spinal anesthesia and general anesthesia on postoperative recovery and discharge time of geriatric patients who underwent day surgery of ureteroscopic lithotripsy.Methods A total of 60 patients aged≥65 years who underwent day surgery of ureteroscopic lithotripsy after in our hospital from January 2019 to December 2019 were selected,all of whom were rated gradeⅡ-Ⅲby the American association of anesthesiologists(ASA).All patients were randomly divided into two groups:general anesthesia group(30 cases)and selective spinal anesthesia group(30 cases).In general anesthesia group,remifentanil 1μg/kg and propofol 2 mg/kg were slowly injected intravenously to induce anesthesia.After the eyelash reflex disappeared,the appropriate laryngeal mask was inserted.Patients inhaled oxygen containing 60%nitrous oxide,while injecting halothane(4%expirations)to maintain anesthesia.In the spinal anesthesia group,5 mg 0.5%bupivacaine was injected into the intervertebral space between the fourth and fifth lumbar vertebrae in a sit-ting position.Operation time,anesthesia preparation time,anesthesia related time in the operating room,anesthesia rapid recovery time,postanesthesia care unit(PACU)stay time,sitting time,out of bed activity time and discharge time of 2 groups were recorded.Hemodynamic parameters,incidence of malignancy/vomiting,surgeon and patient satisfaction with anesthesia,perioperative midazolam-ofentanyl use,and postoperative pain were assessed by an operating room anesthesiologist.Results The exact time of anesthesia,operation time,time related to anesthesia in the operating room,time to start sitting and start moving out of bed in the general anesthesia group were shorter than those in the spinal anesthesia group(P<0.05),while the time to wake up and discharge were higher than those in the spinal anesthesia group(P<0.05).The blood pressure and heart rate in general anesthesia group were significantly lower than those in spinal anesthesia group at anesthesia induction and 1,3,5,10 and 30 min after anesthesia induction(all P<0.05),while SpO2 was higher than that in spinal anesthesia group(P<0.05).There were no significant differences in anesthesia satisfaction,perioperative midazolam-ofentanyl use and postoperative pain between two groups(all P>0.05).Conclusions Spinal anesthesia is a safe and effective method of anesthesia in elderly patients undergoing ureteroscopic lithotripsy during daytime.