高龄前列腺增生患者经尿道电切汽化术的麻醉

目的：探讨高龄高危前列腺增生患者经尿道前列腺电切汽化切割术麻醉的方法及其安全性。方法：将80例75～94岁的患者随机分为腰-硬联合麻醉（combined spinal-epidural anesthesia,CSEA）组和硬膜外麻醉（epidural anesthesia,EA）组,各40例,观察各组麻醉起效时间,阻滞平面,镇痛和肌松效果,局麻药和静脉辅助药的用量及术中SAP,DAP,HR,RR,SpO2的变化,术后随访有无头痛、恶心、呕吐等副作用。结果：CSEA组比EA组麻醉起效快,镇痛及肌松效果好。局麻药和辅助药用量少（P〈0.01）,术中血流动力学变化及术后随访两组无显著差异。结论：CSEA用于高龄高危前列腺增生患者经尿道电切汽化术的麻醉安全有效,围手术期个体化处理及麻醉操作和用药是关键。

Anesthesia in transurethral electro-vaporization-ablation of prostate for aged patients with benign prostatic hyperplasia

Objective:To explore the method and safety of anesthesia adopted in transurethral electro-vaporization-ablation of prostate(TUEVAP)for aged patients with benign prostatic hyperplasia.Methods:Eighty patients aged from 75 to 94 were randomly divided into two groups,each including 40 patients.One group received combined spinal-epidural anesthesia(CSEA),and the other group received epidural anesthesia(EA).During anesthesia,the onset time,blocking plane,the quality of analgesia and muscle relaxation,dose of local anesthetic and supplemental intravenous anesthetic,and the variation of SAP,DAP,HR,RR,SpO2 were compared.After operation,the side effect such as headache,postoperative nausea and vomiting were observed.Results:The onset time of sensory block was shorter in the CSEA group compared to that in the EA group,and the quality of analgesia and muscle relaxation was better in CSEA group.The dose of local anesthetic and supplemental intravenous anesthetic used in CSEA group was less than that used in EA group(P<0.01).There was no significant difference in the hemodynamic changes and postoperative side effect between the two groups.Conclusions:CSEA can be safely and effectively applied to aged benign prostatic hyperplasia patients in transurethral electro-vaporization-ablation of the prostate.The key is individualized perioperative treatment and anesthetizing operation.