老年患者全麻联合硬膜外麻醉和全身麻醉效果的比较

目的比较老年患者全麻联合硬膜外麻醉和全身麻醉的效果。方法选择60岁以上老年人腹部择期手术患者30例,ASAⅠ～Ⅱ级,随机分成两组,全麻联合硬膜外组（GEA组）与单纯全麻组（GA组）,每组15例。GEA组患者先行硬膜外麻醉,待硬膜外平面确定后,行全麻诱导,气管内插管,术中用丙泊酚泵入维持,根据需要给予少量肌松剂,术后行PCEA。GA组患者常规给予全麻诱导（同GEA组）,气管内插管,术中用丙泊酚、芬太尼、阿曲库胺维持,术后行PCA。记录两组患者全麻药用量;观察两组患者拔管时间,血管活性药的使用情况。观察两组患者术后镇痛情况，并行VAS评分。结果GEA组全麻药用量明显少于GA组（P〈0．05），GEA组拔管时间明显短于GA组（P〈0．05）。结论全麻联合硬膜外阻滞用于上腹部手术，可降低术中丙泊酚用量，拔管时间提前且麻醉安全性增加。

To Compare Epidural Anesthesia Combined with General Anesthesia with General Anesthesia on the Effection of Anesthetics of Elderly Patients

Objective To compare Epidural anesthesia combined with general anesthesia with general anesthesia on the effect of anesthetics of elderly Patients.Methods Thirty ASA Ⅰ-Ⅱ elderly patients undergoing abdominal surgery were assigned randomly to completely total intravenous anesthesia group GA,n=15） or epidural anesthesia combined with total intravenous anesthesia（group GEA,n=15）.Epidural block is performed in group GEA firstly,after block plane comes to the needed level,induction and endotracheal intubation is performed after that.Anesthesia is maintained with propofol and atracurium.PCEA is used in group GEA postoperatively.In group GA,patients receive midazolam,fentanyl and atracurium for induction and followed by endotracheal intubation.Anesthesia is maintained with propofol,fentanyl and atracurium.PCA is used in this group postoperatively.The doses of propofol,fentanyl,atracurium and vasoactive drugs were required and removing intratracheal cannula time were recorded.Results There were significant decrease on the dosage of general anesthesia medicine and removing intratracheal cannula time of GEA.Conclusion Epidural anesthesia combined with general anesthesia in elderly patients can reduce the requirement of propofol,removing intratracheal cannula time earlier and less complication.