老年患者下肢手术应用腰硬联合麻醉和硬膜外麻醉的对比观察

目的 观察比较腰硬联合麻醉（CSEA）和硬膜外麻醉（EA）在老年患者下肢手术中的麻醉阻滞效果及安全性。方法选择60例ASA分级为Ⅱ～Ⅲ级下肢手术老年患者，随机分为两组，每组30例。Ⅰ组采用腰麻-硬膜外联合麻醉（CSEA），Ⅱ组采用连续硬膜外麻醉（EA）。记录两组椎管内注药前（T0）、注药后5min（T1）、10min（T2）、15min（T3）、20min（T4）、30min（T5）及术毕（T6）SBP、DBP、HR、SP02的数值，用Bromage法判定运动神经阻滞情况，观察两组麻醉起效时间、阻滞完善时间、麻醉效果、麻醉合并症及不良反应。结果两组血流动力学组间和组内比较均无统计学差异（P〉0．05）；Ⅰ组麻醉起效时间、阻滞完善时间比Ⅱ组明显短（P〈0．05）；Ⅰ组麻醉效果明显优于Ⅱ组（P〈0．01）；Bromage评分Ⅰ组明显优于Ⅱ组（P〈0．01）；两组间合并症及不良反应发生率差异无统计学意义（P〉0．05）。结论CSEA起效快，肌肉松弛好，麻醉效果确切，用于老年患者的下肢手术是安全有效的。

Comparison of efficacy of combined spinal - epidural anesthesia and epidural anesthesia in elderly patients undergoing lower extremity surgery

Obective To compare the application efficacy and safety of combined spinal - epidural anesthesia （CSEA） and epidural anesthesia （EA） in elderly patients undergoing lower extremity surgery. Methods Sixty cases of lower extremity surgery with ASA Ⅱ- Ⅲ grade elderly patients were randomly divided into two groups with 30 cases each. Group Ⅰ received CSEA and group Ⅱ received EA. The changes of SBP,DBP,HR,SPO2 were recorded before intraspinal injection and after 5 min, 10 min, 15 rain,20 rain,30 min and operation completion time of intraspinal injection, Bromagc scale was used for evaluating motor nerve block, the onset time ,sensory nerve complete block time and effect of anesthesia, the complications and adverse reactions of anesthesia were recorded during each operation. Results No significant differences were observed in hemodynamic changes between two groups （P 〉 0. 05） ; the onset time and sensory nerve complete block time of group I was significantly shorter than that in group Ⅱ （ P 〈 0.05 ） ; the anesthesia effect was considered significantly better in group than that in group Ⅱ （ P 〈 0.01 ） ; Bromage scale in group I was higher than that in group Ⅱ （ P 〈 0.01 ） ; the incidence of complications and adverse reactions in the two groups were not significant （ P 〉 0.05 ）. Conclusion CSEA is a reliable technique which provides more rapid onset of analgesia, and positive muscle relaxation results, it is safe and effective in elderly patients undergoing lower extremity surgery.