丙泊酚-芬太尼静脉麻醉复合局麻在血管旁路移植术治疗LEAOD中的应用

目的通过观察丙泊酚-芬太尼静脉麻醉复合局部浸润麻醉应用于下肢动脉硬化闭塞症(LEAOD)行血管旁路移植术中的麻醉效果,了解该种麻醉方式与气管插管全麻相比在老年患者手术中的优点。方法选择LEAOD行血管旁路移植术患者82例,男71例,女11例,随机分为两组:丙泊酚-芬太尼静脉麻醉复合局部浸润麻醉组(A组)及气管插管全凭静脉全身麻醉组(B组)。每组各41例。观察并记录血压、心率、血氧饱和度、手术时间、术毕麻醉苏醒时间、芬太尼用药量及术后恶心、呕吐的发病率。结果 A、B两组术后第1h、2h的血压与麻醉前相比均降低(P<0.05);而组间血压、心率及血氧饱和度比较,无统计学意义,且均在正常值范围内。A组术后恶心呕吐发病率及芬太尼用药量显著低于B组(P<0.05或0.01);手术时间及术毕麻醉苏醒时间两组未见显著性差异。而B组有4例(9.8%)患者出现拔管困难,被送入重症监测病房(ICU),1周后因呼吸衰竭死亡1例(2.4%)。结论丙泊酚-芬太尼全凭静脉麻醉复合局部浸润麻醉可较有效地应用于LEAOD行血管旁路移植术中,且可避免因全麻气管插管导致老年患者拔管困难的发生。

Application of Propofol - Fentanyl Intravenous Anesthesia Combined with Local Anesthesia in Treatment of LEAOD by Vascular Bypass Surgery

Objective To understand the types of anesthesia and tracheal intubation＇s anesthesia in elderly patients compared to the advantages of surgery by observing protofol-fentanyl intravenous anesthesia combined with local infiltration anesthesia in Lower extremity arterial occlusive disease（LEAOD） with vascular bypass grafting anesthetic effect.Methods To choose LEAOD with vascular bypass grafting 82 patients,ASA Ⅰ-Ⅲ level,71 males,11 females,were randomly divided into two groups： propofol-fentanyl intravenous anesthesia combined with local infiltration anesthesia group（group A） and total intravenous anesthesia endotracheal intubation group（group B）.41 patients in each group.Observe and record blood pressure,heart rate,oxygen saturation,operative time,dosage of fentanyl and the incidence of postoperative nausea and vomiting.Results In group A and B 1,2 h postoperative blood pressure decreased compared with those before anesthesia（P0.05）,while blood pressure,heart rate and blood oxygen saturation between groups were not significant,and were within normal range.The incidence of postoperative nausea and vomiting and fentanyl dosage of group A were significantly lower than group B（P0.01 or 0.05）;operation time and recovery time after surgery were not significant differences between the two groups.4 cases（9.8%） patients of group B had extubation difficulty,were admitted to Intensive Care Unit（ICU）,and one case（2.4%） died of respiratory failure after a week.Conclusion spropofol-fentanyl total intravenous anesthesia combined with local anesthesia can be more effectively applied to LEAOD with vascular bypass grafting,and can avoid tracheal extubation in patients with difficult intubation in the elderly place.