高龄高危患者上腹部手术的麻醉

目的 探讨高龄高危患者上腹部手术治疗的麻醉管理方法.方法 采用随机加大对照方法,选择80例76岁以上择期手术患者分为3组:A组15例为连续硬膜外阻滞麻醉组;B组25例为静吸复合全身麻醉组;C组40例为小剂量低浓度硬膜外阻滞复合静吸全身麻醉组.术中监测心率、血压、心电图、脉搏血氧饱和度、吸呼、镇静镇痛、肌松、苏醒等情况,并行麻醉效果评价.结果 C组苏醒及气管拔管时间明显短于B组,差异有统计学意义(P＜0.05),在气管插管及拔管期,B组血压显著升高,差异有统计学意义(P＜0.05),A组术中探查时血压下降程度明显＞B、C组,且出现明显的牵拉不适、肌紧、脉搏血氧饱和度波动明显,差异有统计学意义(P＜0.05).麻醉效果评价C组明显优于A、B组.结论 小剂量低浓度硬膜外阻滞复合静吸全身麻醉,能够弥补硬膜外或全身麻醉单一方法的不足,避免呼吸抑制、牵拉不适、肌肉紧张和麻醉用量过大引起的不良反应,增加安全范围,适用于高龄患者上腹部手术的麻醉.

Anesthesia of the epigastrium operation for the aged high-risk patients

Objective To discuss the methods of anesthesia of the epigastrium operation for the aged high-risk patients.Methods 80 cases over 76 years old with dated epigastrium surgical operation,were enrolled in this randomized and enlarged control trial,and were divided into 3 groups,A,B and C:A,15 cases enrolled,with continuous epidural block group;B,25 cases enrolled,with combination general anaesthesia of intravenous and inhalation;C,40 patients enrolled,with low-dose and low-concentration epidural anesthesia compounded with general anesthesia of intravenous and inhalation.Monitored HR,BP,ECG,SpO2,RR,sedation and analgesia,muscle-relaxation and palinesthesia during the operation,then evaluated the effects of them.Results The palinesthesia and extubating time of group C were obviously less than that of group B(P<0.05);during intubation and extubation,the blood pressure of group B rose significantly(P<0.05);the degree of falling of BP of group A during explorating was obviously higher than that of group B and group C.Moreover,visible drag complaint,muscle-tightness and SpO2 fluctuation could be seen in group A(P<0.05).The anesthesia effect of group C was better than that of group B and group A.Conclusion Low-dose and hypo-concentration epidural anesthesia compounded with general anesthesia of intravenous and inhalation could make up the shortage of single use of epidural block or general anesthesia and avoid breath restraining,drag complaint,muscle tightness and untoward reaction caused by large dose of narcotic,and increase safety range.Therefore,it refers to the epigastrium operation for the aged high-risk patients.