老年开胸手术不同浓度罗哌卡因硬膜外阻滞复合全麻效果比较

目的:比较老年开胸手术不同浓度罗哌卡因硬膜外阻滞复合全麻效果及其安全性。方法:45例择期行开胸手术的食管中下段癌患者,随机分为生理盐水组(A组)、0.25%罗哌卡因组(B组)和0.5%罗哌卡因组(C组),每组均为15例。全麻诱导后,每60minB组和C组硬膜外腔间断注入相应浓度罗哌卡因5ml辅助术中镇痛,A组注射等体积的生理盐水。记录各个时期平均动脉压(MAP)、心率(HR)值,术毕各组呼吸恢复时间、呼之睁眼时间、拔管时间及术后相关并发症。结果:全麻诱导后,3组HR、MAP均下降(P<0.05~P<0.01)。在气管插管后、手术初期、拔管时期,A组HR、MAP显著升高(P<0.01);B组HR、MAP波动较小(P>0.05);C组HR在手术期下降(P<0.01),MAP在插管后各时期显著降低(P<0.01)。与A组比较,B组和C组呼吸恢复时间、呼之睁眼时间、拔管时间缩短(P<0.01),B组和C组比较差异均无统计学意义(P>0.05)。术后随访均无术中知晓、恶心呕吐、呼吸抑制。A组术后有1例烦躁。结论:0.25%罗哌卡因硬膜外阻滞复合全麻可以安全、有效地用于老年开胸手术患者麻醉。

Comparison of different concentrations of ropivacaine for epidural anesthesia combined with general anesthesia in thoracic surgery for elderly patients

Objective：To compare the anesthetic effect of anesthsia epidural block with different concentrations of ropivacaine on elderly patients receiving thoracic surgery. Methods：Forty-five patients receiving thoracic surgery were randomly divided into normal saline group （group A） , 0.25% ropivacaine group （group B ）and 0.5% ropivacainc group （group C ） , with 15 cases in each. After induction of anesthesia,group B and group C were injected 5 ml ropivacaine of corresponding concentration every 60 min to the epidural cavity, and group A were injected 5 ml saline. The MAP, HR, the time of breathing recovery, opening eyes, extuhation and the side effects after anesthesia were recorded. Results ： HR and MAP decreased in all the three groups after anesthesia induction （ P 〈 0. 05 to P 〈 0. 01 ）. After tracheal intubation, the HR and MAP increased significantly in group A （ P 〈0. 01 ）, fluctuated mildly in group B （ P 〉 0.05 ） and decreased greatly in group C. The time of breathing recovery, opening eyes and extubation in group A was significantly longer than that in group B and group C （ P 〈 0. 01 ） , and there was no obvious difference between group B and group C （ P 〉 0. 05 ）. No nausea,vomiting or respiratory depression were observed during the operation in all the three groups. One patient in group A presented irritability. Conclusions ：0.25% ropivacaine epidural anesthesia combined with general anesthesia can be safely and effectively used in elderly patients undergoing thoracic surgery.