老年高危病人硬膜外阻滞联合全身麻醉的相关处理

目的:评价小剂量低浓度硬膜外阻滞复合全麻应用于老年高危病人手术的可行性。方法:35例老年高危病人,ASAⅡ～Ⅳ级,根据病人手术部位选择硬膜外穿刺,注入1 5%～1 7%利多卡因4～6mL ,5～1 0min ,测定阻滞平面加局麻药,使阻滞平面在控制需要范围。全麻诱导用咪唑安定0 1mg·kg- 1,芬太尼3～5μg·kg- 1,爱可松0 2mg·kg- 1。全麻维持根据临床情况选用0 1mg %芬太尼加4mg %维库溴铵输注5～1 5mL- 1·h- 1,间断注入维库溴铵维持肌松。多功能监护仪监测心血管功能,术前切皮后和手术结束时测定血浆血管紧张素和血糖。结果:硬膜外阻滞复合全麻应用于老年高危病人的手术,麻醉诱导时血压下降,经过补充液体后可纠正。结论:硬膜外阻滞复合全麻用于老年患者行手术血流动力学较为稳定,应激反应小,全麻药用量和术后躁动减少。但是老年高危病人注意用小剂量、低浓度的局麻药。插管时异丙酚用量要减少。

The Clinical Value of Epidural Block Combined with General Anesthesia in Surgical Operation for High-risk Aged Patients

Objective: To assess the practicability of epidural block combined with complex general anesthesia applying low dose and concentration of drug for high-risk aged patients. Methods: 35 high-risk aged patients (ASA grade II-IV) were punctured to epidural according to their surgical area and injected with 1.5%～1.7%lidocaine by 4～6mL,and then measured blockade range after 5～10min. Local anesthetic could be added on the basis of blockade level in order to control blockade level within the required ranges. Midazolam 0. 1mg.kg -1 ,fentanyl 3～5μg.kg -1 , and esmeron 0.2mg.kg -1 were used for induction of general anesthesia. According to the clinic situation, 0. 1mg%fentanyl was associated with 4mg% veuronim bromide (5～15mL·h -1 for injection) during general anesthesia, interrupted by the injection of vecuronim bromide so as to maintain muscle relaxation. Patients’cardiovascular function should be inspected by the multi-functional patient monitor. Plasma levels of angiotensin II (AngII) and blood sugar should be determined respectively before skin incision and after surgery.Results: Complex general anesthesia of epidural blockade was suitable for surgery of high-risk aged patients. If blood pressure declines during the induction of anesthesia, it can be corrected by the supplement of liquid.Conclusion: The application of complex general anesthesia combined with epidural block for high-risk aged patients can set the blood flow dynamics at rest and lighten the emergency reaction. Dose of medicine for general anesthesia and agitation after surgery are decreased.However, care must be taken that only low dose and concentration of local anesthetic can be applied high-risk aged patients.The dose of diprivan should be reduced during the intubation.