西藏高原地区腰麻联合硬膜外麻醉与硬膜外麻醉的临床比较研究

目的:探讨腰麻联合硬膜外阻滞在西藏高原地区用于下腹及下肢的手术的临床效果。方法:36例在腰麻联合硬膜外阻滞下行下肢及下腹部手术病人(CSEA组),根据手术需要选择单点法或双点法,以26 G腰麻穿刺针通过硬膜外针刺入蛛网膜下腔,注入局麻药物重比重0．5％布比卡因0．2 mg体重(Kg),记录两组病人入手术室时和麻醉后10、30、60 min 的血压、心率以及氧饱和度;麻醉到手术开始的时间;麻醉效果;术后恢复情况,有无并发症等。选择既往2004年硬膜外麻醉病例36例作为对照组(EA组)。结果:EA组在麻醉时间和手术开始时间均明显大于CSEA组(P<0．05);在麻醉后 10min,EA组舒张压明显下降(P<0．05),CSEA组收缩压及舒张压均明显下降,麻醉后30及60min,两组病人血压均有升高,与麻醉前对比无明显差异(P>0．05);EA组病人在麻醉后吸氧(2～4)L／min,麻醉后10、30、60 min SpO2都明显高于麻醉前(P<0．01);CSEA组麻醉后10 min在未吸氧的情况下SpO2明显高于麻醉前(P<0．05),麻醉后30、60 min吸氧(2～ 4)L／min SpO2明显高于麻醉前(P<0．01)。结论:CSEA在高原环境下是安全可行的,在下腹和下肢手术中是一个比较理想的麻醉选择,与硬膜外阻滞相比,其麻醉药用量小,作用快、效果确切,对呼吸影响轻微,但对有明显心肌缺血的病人应慎用。

Comparative clinical study between spinal combined epidural anesthesia and epidural anesthesia in Tibet

To investigate the effect of spinal combined epidural anesthesia used for inferior belly and the lower limb operation in Tibet plateau area. Methods: 36 patients who would undergo elective inferior belly and lower limb operations were performed spinal and epidural anesthesia(CSEA group) . Single or double space tests were adopted according to the operative requirement. 26 G transfixion pin was pricked into subarachnoid space through epidural needle and heavy specific gravity local anesthetics were infused. Heart rate, blood pressure and SpO2 were monitored when the patients entered the operation room and after anesthesia 10, 30 and 60 min. The anesthesia effects, recovery of aesthema and post-operative complications were recorded. Another 36 patients who had experienced epidural anesthesia last year were selected as the control group(EA group) . Results: The anesthesia time and the beginning time of surgery in EA group were longer than those in CSEA group. After anesthesia 10 min, the diastolic blood pressure in EA group decreased significantly, systolic blood pressure and diastolic blood pressure decreased in CSEA group as well. After anesthesia 30 and 60 min, the blood pressure stepped up to the normal level. After anesthesia 10 min, SpO2 increased significantly in CSEA group without inhaling O2 than that before anesthesia(p<0.01). With inhaling O2 SpO2 after anesthesia 30 and 60 min was higher in CSEA group than that before anesthesia(p<0.01) . Conclusion: CSEA is safe and feasible in Tibet plateau area and is an ideal anesthetic choice for the inferior belly and lower limb surgery.