全麻复合硬膜外阻滞用于老年慢性阻塞性肺疾病患者手术

目的:探讨全麻复合硬膜外阻滞(GEA)用于COPD老年患者手术的可行性和安全性。方法:32例择期行上腹部和胸腔手术的老年患者随机均分为GEA组和单纯全麻(GA)组,术后分别采用硬膜外和静脉镇痛,记录手术时间、术后苏醒和拔除气管导管时间、术后镇痛效果(VRS评分)和术后呼吸系统事件,测定手术次日晨FVC、FEV_1/FC%、FEF_(25%～75%)。结果:术后苏醒和拔除气管导管时间GEA组较GA组明显缩短(P<0.05),术后镇痛GEA组明显优于GA组(P<0.05),呼吸系统事件的发生率GA组高于GEA组,手术次日晨测定FVC、FEV_1/FC%、FEF_(25%～75%)值GEA组与GA组存在明显差异(P<0.05),GEA组肺功能的恢复明显好于GA组。结论:全麻复合硬膜外阻滞可缩短苏醒时间和提高苏醒质量,术后镇痛完善,利于术后恢复,用于合并有COPD老年患者的手术是一种安全、有效、切实可行的麻醉方法。

Clinical Observation of General Anesthesia Combined Epidural Block on Old Patients with COPD

Objective:To investigate the feasibility and safety of general anesthesia combined epidural block(GEA)on old pa- tients with COPD.Methods:Thirty two patients scheduled for selective epigast or thoracic surgery were randomly divided into two groups,GEA group and GA group(general anesthesia).Patient-controlled epidural analgesia and patient-controlled intrave- nous analgesia were used respectively after operation.Record surgery duration,waking time,extubation time,visual analgesia score and rate of incidence of respiratory system were recorded,FEV_1/FC%,FEF_(25-75%)were measured in the morning the next day.Results: The waking time and extubation time of GEA group was significantly shorter than those in GA group(P<0.05).The rate of the inci- dence of respiratory system was lower than that of GA group(P<0.05).The effect of analgesia in GEA was more superior than that in GA group(P<0.05),the recovery of pulmonary function was better in GEA group than that in GA group(P<0.05).Conclusion: General anesthesia combined epidural block in old patients with COPD is a safe,effective and feasible method which can decurtate the time of analepsia and improve quality of resuscitation,supply perfect analgesia and better postoperative recovery.