腰硬联合麻醉和硬膜外麻醉用于经尿道前列腺切除术的对比研究

目的比较腰硬联合阻滞麻醉(CSEA)和硬膜外阻滞麻醉(EA)在经尿道前列腺切除术(TURP)的临床效果及安全性。方法 80例ASA分级为Ⅱ～Ⅲ级择期TURP老年患者,66～82岁,随机分为CSEA组和EA组各40例。CSEA组采用腰硬联合麻醉,选择L2～3或L3～4穿刺注入小剂量布比卡因;EA组采用硬膜外麻醉,选择L2～3或L3～4穿刺注入利多卡因。观察并记录两组患者麻醉起效时间、麻醉阻滞完善时间、麻醉效果、麻醉合并症和用药后的不良反应,用Bromage法评定运动神经阻滞情况,记录两组椎管内注药前(T0)、注药后5min(T1)、10min(T2)、15min(T3)、20min(T4)、30min(T5)及术毕(T6)SBP、DBP、HR、SPO2的参数。结果 CSEA组麻醉起效时间、阻滞完善时间比EA组短(P<0.05);CSEA组麻醉效果、Bromage评分明显优于EA组(P<0.01);两组间和组内血流动力学比较及合并症、不良反应发生率差异无统计学意义(P>0.05)。结论 CSEA和EA两种椎管内麻醉方法均可安全用于TURP老年患者,而CSEA麻醉起效更快,肌肉松弛好,血流动力学稳定,麻醉效果更确切且安全有效。

Study of Comparison of Combined Spinal-epidural Anesthesia and Epidural Anesthesia in Elderly Patients Undergoing Transurethral Resection of the Prostate

Objective To compare the application efficacy and safety of combined spinal-epidural anesthesia （CSEA） and epidural anesthesia （EA） in elderly patients undergoing transurethral resection of the prostate（TURP）. Methods Eighty cases of TURP with ASA Ⅱ～Ⅲ grade elderly patients（66～82 years old）were randomly divided into two groups with 40 cases each. Group CSEA received combined spinal-epidural anesthesia and was performed at L2～3 or L3～4 with low-dose bupivacaine;group EA received epidural anesthesia and was performed at L2～3 or L3～4 with lidocaine. The onset time of anesthesia、 sensory nerve complete block time and effect of anesthesia, the complications and adverse effects of anesthesia were observed and recorded during each operation. Bromage scale was used for evaluating motor nerve block. The changes of SBP、DBP、HR、SpO2 were recorded before intraspinal injection （T0）and after 5min（T1）、10min（T2）、15min（T3）、20min（T4）、30min（T5） and operation completing time（T6） of intraspinal injection. Results No significant differences were observed in hemodynamic changes between two groups （P〈0.05）; the onset time ofnesthesia and sensory nerve complete block time of group CSEA was significantly shorter than that in group EA（P〈0.05）;the anesthesia effect was considered significantly better in group CSEA than that in group EA （P〈0.01）; Bromage scale in group CSEA was higher than that in group EA （P〈0.01）;the incidence of complications and adverse effects in the two groups were not significant（P〈0.05）. Conclusion Two intraspinal anesthesia methods of CSEA and EA are safe in elderly patients undergoing TURP. CSEA is a reliable technique which provides more rapid onset of analgesia, stable hemodynamics, positive muscle relaxation results, and more safe and effective of anesthesia.