老年患者全身麻醉和脊柱麻醉后的诱导、维持和复苏特性分析

目的：比较使用3种全身麻醉方法和脊髓麻醉对老年患者的诱导和复苏特性。方法研究对象为100例接受尿道手术的60岁以上患者，根据麻醉方式不同分为丙泊酚-丙泊酚（ P-P ），丙泊酚-异氟烷（P-I），丙泊酚-地氟烷（P-D）组，每组25例，分别由芬太尼（1～2μg/kg IV）和丙泊酚（1．0～2．0 mg/kg IV）诱导麻醉，并分别用含70％N2 O的氧气同时注射丙泊酚（75～150μg· kg-1· min-1）或异氟烷（呼气0．7％～1．2％）或地氟烷（呼气1％～4％），维持麻醉状态。诱导麻醉后接上通气喉罩，维持自主呼吸。在脊髓麻醉组（S），患者鞘内注射1．5 mL溶于等体积10％葡萄糖注射液中的4％利多卡因（60 mg）麻醉。结果与脊髓麻醉相比（9．3±3．4）min，丙泊酚诱导麻醉的技术方法比较简单并且诱导速度更快（P＜0．01）（P-P，P-I和P-D组麻醉的诱导时间分别为（4．6±1．7）min，（4．7±2．2）min和（3．8±1．4）min。在诱导期内，S组病例的主动脉压和心率更高。3个全身麻醉组患者，在麻醉诱导，拔管和定位时间相近。 S组病例产生疼痛得分更低（P＜0.05），但复苏观察时间更长（P＜0．01）。 P-P和P-D组患者数字符号替换测验（DSST）得分恢复到基础水平的时间比P-I组稍短。麻醉方法不同对于患者术后恶心，嗜睡，焦虑和协调性没有影响。结论老年患者使用丙泊酚和地氟烷诱导全身麻醉可以缩短诱导和复苏时间，且不会产生副作用。因此这种方法适用于老年患者在经尿道手术中使用。

The analysis of induction,maintenance and recovery characteristics between general anesthesia and spinal an-esthesia in elderly patients

Objective To compare three methods of general anesthesia and spinal anesthesia in elderly patients with induction and recovery characteristics.Methods 100 patients undergoing urethral operation patients over 60 years were used to test.According to the different anesthesia methods,they were divided into propofol and propofol （ P-P） ,propofol,isoflurane,desflurane and propofol （ P-I）-（ P-D） cases,each group in 25 cases,by ventani （1-2μg/kg IV） and propofol （1.0-2.0mg/kg IV） induced anesthesia respectively,and with 70% N2 O oxygen and injection of propofol 75-150μg/（kg· min）] or isoflurane0.7%-1.2% of desflurane （breath） or breath 1%-4%] ,maintain anesthesia.After induction they were went on with laryngeal mask ventilation, maintain autonomous breathing.In the spinal anesthesia group（S）,1.5 lidocaine ML were intrathecal injection by dissolved in 10%glucose. Results To compared with spinal anesthesia （9.3 ±3.4） min,propofol induced anesthesia method was relatively simple and induce faster （P〈0.01）.P-P,P-I and P-D group anesthesia induction time was （4.6 ±1.7）min,（4.7 ± 2.2）min and （3.8 ±1.4）min.In the induction period,patients in group S were higher aortic pressure and heart rate. 3 general anesthesia patients were similar to the time in induction of anesthesia,extubation and orientation patients in group S were lower（P〈0.05）,but the recovery was longer （P〈0.01）.The P-P and P-D group,Digit Symbol Sub-stitution Test（ DSST） scores returned to baseline levels of time slightly shorter than that of group P-I.patients with dif-ferent methods of anesthesia had the same with postoperative nausea, somnolence, anxiety and coordination. Conclusion Induction and recovery time can be shortened in the elderly patients by using propofol and desflurane has no side effects.Therefore this method is suitable for elderly patients with transurethral operation using.