全麻复合硬膜外阻滞用于老年高血压患者上腹部手术

目的:评价全麻复合胸段硬膜外阻滞用于老年高血压病人上腹部手术的优缺点。方法:择期行胃癌根治术老年患者42例,术前合并Ⅰ~Ⅱ期高血压(按WHO标准确诊),随机分成两组(每组21例):A(单纯全麻)、B(硬膜外复合全麻)。两组全麻诱导均用咪唑安定,芬太尼、依托咪酯、阿曲库铵;麻醉维持吸入安氟醚,静脉输注异丙酚,间断追加芬太尼,阿曲库铵;B组硬膜外穿刺选择T8~9间隙,置入硬膜外导管,局麻药用1%利多卡因+0.25%布比卡因混合液;术中连续监测BP、HR、SpO2心率;记录术中知晓、术后躁动及麻醉药用量。结果:插管及拔管时,A组SBP、MAP、HR、RPP均明显高于麻醉前值(P<0.01),术后60及90 m inSBP、MAP、HR显著升高;同期B组无明显波动,组间比较差异显著(P<0.01);术毕至清醒时间A组(35.0±15.2)m in,B组(10.0±4.6)m in,组间比较差异显著(P<0.01)。结论:静脉全麻复合硬膜外阻滞麻醉方法用于老年高血压病人上腹部手术,血流动力学波动小,全麻药用量和术后躁动减少,病人恢复快。

Effects of combination of general and epidural anesthesia on hemodynamics for elderly hypertensive patients undergoing upper abdominal surgery

Objective:To observe the influences of general combined with epidural anesthesia on hemodynamics for upper abdominal surgery in elderly hypertensive patients.Methods: Fourty-two cases with stage I to II hypertension were randomly divided into two groups,general anesthesia(group A,21 cases) and general combined with epidural anesthesia(group B,21cases).SBP,MAP,HR,RPP were monitored in different time.Intraoperative awareness,postoperative restlessness and anesthetic dosages were recorded.Results:SBP,MAP,HR,RPP were significantly higher than those before anesthesia during intubation and extubation in group A(P<0.01),and(increased) significantly at 60,90 min postoperation,but there was no significant change in group B.Conclusion: Compared with the two different methods,epidural block combined with general anesthesia is better for elderly(hypertensive) patients with gastric carcinoma surgery,because it reduces anesthetic dosage with less postoperative restlessness and the stress response.