腰麻-硬膜外联合麻醉和硬膜外麻醉在高龄患者经尿道前列腺电切术中的价值比较

目的评价腰麻-硬膜外联合麻醉和硬膜外麻醉在高龄患者经尿道前列腺电切术(TURP)的麻醉效果及安全性。方法 120例择期行TURP的高龄患者,年龄75～92岁,随机分为两组,连续硬膜外麻醉(EA)组(n=60);腰麻-硬膜外联合麻醉(CSEA)组(n=60)。监测ECG、BP、HR、RR和SpO2,用针刺法测定两组的痛觉减退平面(镇痛平面)和痛觉消失平面(麻醉平面),记录感觉阻滞起效时间(指给药后感觉阻滞部位发热、麻木等的时间),镇痛持续时间,用改良的Browage分级法评定运动阻滞效果,记录运动阻滞起效时间(指给药后抬下肢感觉无力的时间),达最大运动阻滞时间、最大阻滞节段、运动阻滞的持续时间,评定麻醉效果,术后随访腰麻后头痛、呕吐等不良反应。结果感觉阻滞起效时间:EA组明显慢于CSEA组(P<0.01)。痛觉阻滞持续时间:EA组明显小于CSEA组(P<0.01)。EA组屈髋、屈膝及屈踝不能的起效时间和维持时间均明显慢于和短于CSEA组(P<0.01);最大Browage分级EA组小于CSEA组(P<0.05);EA组中有12例术中由于麻醉不全、有痛感而辅助静脉镇痛药,其中2例因不能耐受手术而改气管插管全麻;CSEA组中无1例辅助静脉镇痛药和改全麻,CSEA组麻醉效果明显优于EA组(P<0.05)。CSEA组术后无1例腰麻后头痛和神经系统并发症发生。结论只要严格控制注药速度和麻醉平面,采用小剂量局麻药,术中精心管理,腰麻-硬膜外联合麻醉应用于高龄患者TURP中是安全的,麻醉效果是确切的,与硬膜外麻醉比较有很大的优越性,可作为高龄患者TURP的首选麻醉方法 。

Compared on senile patients' TURP in combined spinal-epidural anesthesia and epidural anesthesia

Objective To assess the efficacy of combined spinal-epidural anesthesia(CSEA)and epidural anesthesia(EA)on senile patients undergoing transurethral resection of prostate(TURP)and their safety.Methods One hundred and twenty elderly patients undergoing TURP,aged 75 through 92 years,were randomly divided into two groups,i.e.continuous epidural anesthesia group(EA group,n=60)and combined spinal-epidural anesthesia group(CSEA group,n=60).Monitored indexes included electrocardiogram,blood pressure,heart rate,respiratory rate and pulse oxygen saturation during anesthesia.The levels of hypalgesia and analgesia were measured by acupuncture.The onset and duration of sensory block were recorded(the onset of sensory block was the time when the part of the sensory block became hot and numb after administration).The effect of motor block was evaluated with Browage modified scale score.The onset and duration of motor block,the peak time of motor block and the block height were recorded and then the effect of anesthesia was assessed(the onset of motor block was the time when the patients feel unable to raise their lower limbs after administration).The headache after lumbar anesthesia,vomiting and other adverse effects were noted after operation.Results The onset and duration of sensory block were significantly later and shorter in EA group than in CSEA group(P<0.01).The onset and duration of failing to flex the hip,knee and ankle joints were significantly later and shorter in EA group than in CSEA group(P<0.01).The score of Bromage scale was lower in EA group than in CSEA group(P<0.05).There were twelve patients in group EA who needed to complement intravenous analgetic medicine due to imcomplete anesthesia,and two of the twelve patients had to divert the anesthetic program to endotracheal anesthesia.CSEA group members neither needed to complement intravenous analgetic medicine nor needed to divert the program.The effect of CSEA group was significantly superior to EA group(P<0.05).None of CSEA group occurred headache and nervous system complications.Conclusion CSEA can be used safely and effectively for the elderly patients undergoing TURP so long as the injection speed and analgesia level are controlled strictly in addition to the use of small dose anesthetic and careful management during the operation.CSEA,superior to EA,is the preferred method for the elderly patients undergoing TURP.