腰椎脊髓减压内固定手术160例的麻醉体会

目的探讨维持老龄脊柱手术中生命体征平稳的麻醉管理方式。方法对120例腰椎脊髓减压内固定的手术患者麻醉均采用气管插管静吸复合麻醉方式。将患者随机分为治疗组60例;对照组60例:治疗组麻醉诱导用咪唑安定0.15mg/kg,维库溴铵0.1mg/kg,芬太尼3μg/kg;对照组麻醉诱导用得普利麻1.5mg/kg,维库溴铵0.1mg/kg,芬太尼3μg/kg。治疗组术中麻醉维持用(1.0±0.5)MAC安氟醚吸入,芬太尼1μg/(kg.h),咪唑安定0.05mg/(kg.h);对照组麻醉维持用(1.0±0.5)MAC安氟醚吸入,芬太尼1μg/(kg.h),得普利麻0.5mg/(kg.h);术中监测HR,MAP。结果治疗组在插管后5min HR,MAP(较诱导前下降<20%,较诱导前下降20%～30%,较诱导前下降>30%)下降的例数及HR,MAP的数值均小于对照组(P<0.05)。结论咪唑安定全麻诱导平稳,有利于保持老龄患者全麻诱导时血液动力学的稳定,适用于老龄龄手术患者麻醉。

Anesthetic management of decompression of lumbar spinal canal and internal fixation operation in old age cases

Objective To explore the anesthetic management to maintain stable vital sign in spinal operation in old age cases.Methods Totally 120 cases with decompression of lumbar spinal canal and internal fixation operation using trachea cannula and combined inhalation and intravenous anesthesia were randomly divided into two groups,treatment group(n=60) use midazolam(0.15mg/kg),vecuronium bromide(0.1mg/kg),Fentanyl(3μg/kg) for anesthesia induction,and use enflurane inhalation anesthesia(1.0±0.5)MAC,fentanyl1μg/(kg·h)],midazolam0.05mg/(kg·h)] for maintenance of anesthesia;control group(n=60) use propofol(1.5mg/kg),vecuronium bromide(0.1mg/kg),fentanyl(3μg/kg),midazolam(0.15mg/kg) for anesthesia induction,and use enflurane inhalation anesthesia(1.0±0.5)MAC,fentanyl1μg/(kg·h)],Propofol0.5mg/(kg·h)] for maintenance of anesthesia.monitoring HR,MAP intra-operation.Results The number of cases that the HR and MAP decreased in 5 minuts after trachea cannula(decrease <20% compared with before anesthesia induction;decrease 20%-30% compared with before anesthesia induction;decrease >30% compared with before anesthesia induction) and the HR,MAP in treatment group was less than control group(P<0.05).Conclusions There had stable anesthetic effect using midazolam for general anesthesia induction,the HR and MAP fluctuation,and was suitable for old age surgical cases.