瑞芬太尼氧化亚氮复合硬膜外麻醉在老年人上腹部手术中的应用研究

目的探讨瑞芬太尼氧化亚氮复合硬膜外麻醉用于老年人上腹部手术的可行性。方法选择上腹部手术患者40例,年龄65~78岁,ASAⅡ~Ⅲ级,随机分成两组(R组和Y组)。R组(n=20)以微泵输注瑞芬太尼0.1~0.3μg/(kgmin)、吸入60%氧化亚氮与硬膜外阻滞维持麻醉。Y组(n=20)以吸入60%氧化亚氮与硬膜外阻滞维持麻醉。记录各组麻醉诱导前(T1)、麻醉诱导后手术开始前收缩压(SBP)最低值时(T2)、探查时(T3)及气管拔管时(T4)的SBP、舒张压(DBP)和脉搏(P)的变化。结果R组麻醉诱导后至手术开始前SBP、DBP、P与麻醉前比较无明显变化(P>0.05)。Y组SBP、DBP麻醉诱导后至手术开始前均低于麻醉前(P<0.01),P也较麻醉前慢(P<0.05)。Y组SBP、DBP在T2、T3均较R组低(P<0.01)。结论瑞芬太尼氧化亚氮复合硬膜外麻醉用于老年人上腹部手术,术中循环较氧化亚氮复合硬膜外麻醉组稳定。

Application Research on Epidural Anesthesia Combined with Remifentanil and Nitrous Oxide in the Elderly Patients undergoing upper Abdominal Surgery

Objective To investigate the application feasibility of epidural anesthesia combined with remifentanil and nitrous oxide in the elderly patients undergoing upper abdominal surgery. Methods Forty ASA Ⅱ-Ⅲ patients who aged from 65 to 78.They were randomly assigned to two groups（group R and group Y）. Anesthesia was maintained intravenous infusion with 0.1 to 0.3ktg/（kg·min） remifentanil, inhalation on 60% nitrous oxide and epidural block in group R （n =20）. while in group Y （n=20） anesthesia was maintained with epidural block combined of 60% nitrous oxide. SBP, DBP and pulses were recorded before anesthesia induction（T1）,The lowest SBP at the time from anesthesia induction to operation （T2）, during exploration （T3） and tracheal extubation （T4）. Results SBP, DBP and pulses didn＇t change significantly during the time from anesthesia induction to operation in group R （P〉0.05）. In group Y, both SBP and DBP value measured during the time from anesthesia induction to operation were lower than that before anesthesia （P〈0.01）,the changes of pulses were the same（P〈0.05）. At the time of T2 and T3, both SBP value and DBP value in group Y were lower than in group R（P〈0.01）. Conclusion Epidural anesthesia combined with remifentanil and nitrous oxide are superior to epidural anesthesia combined with nitrous oxide, in terms of hemodynamic stability in elderly patients undergoing upper abdominal surgery.