腰-硬联合麻醉用于老年患者下腹部及下肢手术观察

目的探讨等比重布比卡因腰-硬联合麻醉用于老年患者下腹部及下肢手术的安全性和可行性。方法择期行全髋关节置换术、人工股骨头置换术和前列腺电切术（TURP）的老年患者60例，ASAⅡ～Ⅲ1级，随机分为硬膜外组（EA组）和腰-硬联合麻醉组（CSEA），每组30例。于L13-4或L2-3间隙穿刺，EA组采用连续硬膜外麻醉给药，CSEA组以0．1ml／s的速度向蛛网膜下隙注入等比重混合局麻药布比卡因6～10mg，术中酌情于硬膜外给予2％利多卡因维持麻醉。用针刺法测观察两组感觉阻滞平面及起效时间，用改良Bromage法测运动阻滞程度，观察两组局麻药用量和麻醉效果及其不良反应。结果CSEA组感觉阻滞起效时间、阻滞完善时间明显快于EA组（P〈0．01）。CSEA组的麻醉效果优于EA组（P〈0．05）。下肢改良Bromage评分CSEA组优于EA组（P〈0．05或P〈0．01）。术后两组不良反应无显著性差异。结论只要控制用药量和麻醉平面，腰-硬联合麻醉用于老年患者是安全和有效的。

Application of CSEA in Lower Abdominal Operation and Lower Limb Operation for Aged Patients

Objective To study the safety and efficacy of the combined spinal-epidural anesthesia（CSEA） with bupivacaine in lower abdominal operation and lower limb operation for aged patients. Methods Sixty ASA grade Ⅱ -Ⅲ elderly patients were divided into namely group CSEA（ 30 cases） and group EA （epidural anaesthesia,30 cases） , L3 -4 or L2-3 intervertebral space was puncture point in both groups. Continous epidural anesthesia was performed in group EA. Bupivacaine 6-10 mg were injected into subarachnoid at the speed of 0.1 mL/s and appropriate EA was carried out with 2% lidocaine if necessary. Needling method was used for sensory block assessment, modified Bromage scale was used for evaluating motor block meanwhile the dosage efficacy and side effects of drugs were recorded. Results The sensory block and perfect block occurred earlier in group CSEA than in group EA（ P 〈 0.01 ）. Group CSEA had a better effect （P 〈 0. 05 ）. Bromage scale in group CSEA was higher than that in group EA （ P 〈 0. 05 or P 〈 0.01 ）, but the side effect was not different significantly between two groups. Conclusion Combined spinal- epidural anaesthesia with correct dosage of bupivacaine is safe and effective in elderly patients.