脊-硬联合麻醉应用于老年人经尿道前列腺电切术的临床研究

目的 观察不同剂量布比卡因脊麻联合硬膜外麻醉在老年人经尿道前列腺电切术(TURP)的麻醉效果及血流动力学影响,探讨布比卡因脊-硬联合麻醉对老年人TURP的安全性和适宜剂量.方法 选择年龄≥65岁、择期TURP的前列腺肥大(BPH)患者90例,随机分为3组,每组30例,均选择L2～3进行穿刺,蛛网膜下腔注入局麻药后向头端...

Clinical Research of Combined Spinal-epidural Anesthesia on Transurethral Resection of Prostate in the Elderly

Objective To investigate the safety and the best dose of bupivacaine combined spinal-epidural anesthesia（CSEA）on transurethral resection of prostate（TURP）in the elderly by observing the effective and hemodynamic respondence with different doses of bupivacaine.Methods Ninety patients with benign prostatic hypertrophy（ASA physical status Ⅰ-Ⅲ,aged65 years）who undergone TURP were divided into three groups randomly（n=30）.CSEA of all patients were performed at the L2-3 interspace with spinal-epidural needle.Epidural catheter place 3.5 cm faced capitulum after local anesthetic was injected into subarachnoid space.Group Ⅰ,Ⅱ,Ⅲ received 5 mg（1.0 ml）,7.5 mg（1.5 ml）,10 mg（2.0 ml）of bupivacaine 0.5% for spinal anesthesia respectively;according to anesthesia block plane,supplemental drugs was infused into epidural space.The time of sensory block appeared and reaching maximum place,the maximum plane of sensory block,the time of motor block appeared and reaching maximum,motor block by modified bromage scale,the value of blood pressure and heart rate in the different periods after spinal administration,the incidence of side-effect were observed.Results There were no significant difference among three groups of the time of sensory block appeared and reaching maximum place（P0.05）.There were significant difference between groupⅡ,Ⅲ and group Ⅰ of the time of motor block appeared（P0.05）;There were no significant difference of motor blockreaching thime among the bromage scale were 2-3 levels in three groups.SBP,DBP and HR of three groups all decreased with different degrees after anesthesia,but no significant differences of group Ⅰ and group Ⅱ compared to their baseline（P0.05）.Few side-effect were observed（P0.05）.Conclusion CSEA is the ideal method of anesthesia to TURP in the elderly for high achievement,sacral nerve blocked perfectly,effect definitly,low dosage.CSEA with 0.5% bupivacaine 1.5 ml（7.5 mg）is the best dose on TURP in the elderly patients,in which the anesthesia is satisfied for the slight hemodynamic respondence and few less side effects.