单侧腰麻硬膜外联合阻滞用于老年人手术的临床观察

目的探讨单侧腰麻硬膜外联合阻滞用于老年患者下腹部或下肢单侧手术的可行性。方法60例拟行下腹部或下肢单侧手术老年患者，ASAⅠ-Ⅲ级，随机分为两组：单侧腰麻硬膜外联合阻滞组（S组）和腰麻硬膜外联合阻滞组（C组），每组30例。记录两组患者感觉阻滞范围、运动阻滞程度、运动阻滞持续时间，监测麻醉前、麻醉开始后5，10，15，20，30min各组患者MAP、HR，并记录两组患者术中需药物治疗例数及术后不良反应发生情况。结果与C组比较，S组患者感觉阻滞范围更广，运动阻滞程度明显，但运动阻滞持续时间短（P〈0．01）。与麻醉前相比，S组患者麻醉后各时点MAP、HR变化无统计学意义（P〉0．05）；C组患者麻醉后10、15minMAP、HR下降（P〈0．01）。C组患者术中需麻黄索或阿托品治疗25例，S组为4例。两组患者均无神经系统并发症发生。结论单倾4腰麻硬膜外联合阻滞用于老年人下腹部或下肢单侧手术，具有良好的麻醉效果，且无明显不良反应。

The use of combined unilateral spinal - epidural anesthesia in elderly patients undergoing lower abdominal or lower extremity surgery

Objective To evaluate the efficacy and safety of using of combined unilateral spinal - epidural anesthesia in elderly patients undergoing lower abdominal or lower extremity unilateral surgery. Methods Sixty ASA Ⅱ -Ⅲ patients undergoing lower abdominal or lower extremity unilateral surgery randomized received combined unilateral spinal - epidural anesthesia （ group S） （ n = 30） or combined spinal - epidural anesthesia （ group C） （ n = 30）. Level of sensory block, degree and duration of motor block were recorded. The degree of motor block was assessed using modified Bromage scale. Mean arterial pressure（MAP） and heart rate （HR） were recorded before anesthesia and at 5, 10, 15,20 and 30 minutes after anesthesia. Cases of ephedrine or atropine used during operation and side effects after operation were also recorded. Results The level of sensory block and modified Bromage scales were significantly higher in group S than in group C. However, duration of motor block was shorter in group S than in group C （ P 〈 0. 01 ）. There were no significant difference in MAP and HR after anesthesia compared with those before anesthesia in group S（ P 〉0. 05 ） , whereas MAP and HR at 10, 15 minutes after anesthesia in group C were significantly decreased compared with those before anesthesia（ P 〈 0.01 ）. The cases used ephedrine or at- ropine of group S and group C were 25 and 4, respectively. No side effect related to nervous system was observed. Conclusion Combined unilateral spinal - epidural anesthesia provides more safe and effective in elderly patients undergoing lower abdominal or lower extremity unilateral surgery than combined spinal - epidural anesthesia.