腰麻联合硬膜外麻醉在老年患者下腹部手术中的应用

目的研究腰硬联合麻醉用于老年患者下腹部手术的可行性和安全性。方法择期拟行下腹手术老年患者80例,ASAⅡ～Ⅲ级,随机分成连续硬膜外阻滞(CEA)组和腰硬联合麻醉(CSEA)组,每组40例。记录麻醉后1 h内平均动脉压(MAP)、心率(HR)及血氧饱和度(SpO2)的变化,并观察起效时间、麻醉平面、麻醉完善时间、麻醉效果,术后随访有无头痛等副作用。结果两组出血量差异无统计学意义,CSEA组血压下降、心动过缓明显少于CEA组(P<0.05),术后均无头痛。CSEA组起效时间、阻滞完善时间明显短于CEA组(P<0.01),CSEA组麻醉效果优良者100%,CEA组麻醉效果优良者80%,CSEA组效果优良者明显高于CEA组(P<0.05),两组麻醉最高平面均在T8以下,差异无统计学意义。结论腰硬联合麻醉可安全、有效用于老年患者下腹部手术。

The applications of combined spinal and epidural anesthesia in elder following abdominal surgery

Objective To evaluate the clinical efficacy and safety of combined spinal and epidural anesthesia （CSEA） in elder patients who nndertahen lower abdominal surgery. Methods 80 elderly patients（ ASA class U -llI） scheduled for selective abdominal surgery were allocated randomly to either continuous epidural anesthesia （CEA） group or combined spinal and epidural anesthesia（CSEA） group （n = 40, each group）. MAP, HR and SpO2 were recor- ded in the first hour after anesthesia. The onset time, sensory block level, perfect time, quality of anesthesia and the side effects such as headache were observed after operation. Results The two groups of bleeding had no significant difference. But the downtrend of blood pressure in CSEA group and bradycardia were significantly less than those in CEA group（ P 〈0.05）. The two groups reported no headache. The onset time and perfect time of anesthesia in CSEA group were significantly shorter than those in CEA group（ P 〈 0.01 ）. The effect of anesthesia in CSEA group（ 100% ） was better than CEA group（80% ）. The anesthetic highest level under T8 did not differ between the two groups. Con-clusion CSEA is a safe and effective method for the elder patients undertahen lower abdominal surgery.