OPLAC喉罩通气全麻联合硬膜外阻滞用于高危老年患者麻醉的体会

目的：探讨OPLAC喉罩通气全麻联合硬膜外阻滞对高危老年患者的影响。方法：50例择期下腹部及下肢手术的老年患者随机分成联合麻醉组（A组）与静脉麻醉组（B组）两组各25例，分别给予OPLAC喉罩通气全麻联合硬膜外阻滞与OPLAC喉罩通气全身麻醉，记录两组患者麻醉前（T0）、诱导后（T1）、喉罩插管时（T2）、喉罩插管后5min（T3）、拔管时（T4）的平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）、麻药用量、清醒时间、拔管时间、Steward苏醒评分以及术后恶心、呕吐并发症发生率。结果：与B组比较，A组患者清醒和拔管时间显著缩短（P〈0．05），苏醒评分明显增加（P〈0．05），患者MAP、HR、Sp02的稳定性显著升高（P〈0．05），麻药用量和术后并发症发生率明显下降（P〈0．05）。结论：OPLAC喉罩通气全麻联合硬膜外阻滞可以减少麻药剂量，患者意识和呼吸功能恢复更快，术后并发症的发生风险减少，更适合高危手术患者。

Experience of application of general anesthesia with OPLAC laryngeal mask airway combined continuous epidural anesthesia for high-risk elderly patients in lower abdominal and lower limb surgery

Objective： To investigate the effects of general anesthesia with OPLAC laryngeal mask airway （LMA） ventilation combined continuous epidural anesthesia for high-risk elderly patients in lower abdominal and lower limb surgery. Methods： 50 patients were randomly divided into two groups（ n = 25 ） ：combined anesthesia group（ Group A ）, intravenous anesthesia group （Group B）. Patients in group A were administrated abdominal epidural block up to T10 induced with 0. 33% ropivacaine （5 ml ·h-1） ; general anesthesia with OPLAC LMA were induced with midazolam（0. 04 mg ·kg -1 ）, fentanyl（2 -6μg· kg-1 ）, propofol（ 1 - 1.5 mg·kg -1 ） and atracurium（0. 1mg· kg-1 ） intravenously and maintained with propofol（50 - 100μg·kg-1·min-1 ） and remifentanil（0. 05 -0. 5μg·kg-1·min-1）, while patients in group B were induced using the same drugs in the same procedures and maintained with propofol （60 - 120 μg·kg-1·min-1） and remifentanil （0.05 - 1μg·kg-1·min-1 ）.Hemodynamic parameters of MAP, HR, SpO2 at time of before induction （ T0 ）, after induction （ T1）, intubation （T2 ）, 5 minutes after intubation （ T3 ）, extubation （ T4 ） ; Anesthetic drug dosage, awake time, extubation time, recovery scale （ Steward）, and incidence of postoperative complications such as nausea, vomiting were recoded. Results： Compared with group B, the time of awake and extubation in group A were significantly decreased （P 〈 0. 05 ）, and recovery scale were significantly increased （P 〈 0. 05 ）. Compared with group B, the stability of MAP）, HR, SpO2 in group A were significantly increased （P 〈 0. 05 ）, while anesthetic drug dosage significantly decreased （P 〈 0. 05 ）. Compared with group B, the incidence of postoperative complications in group A were significantly decreased（P 〈0. 05 ）. Conclusion： General anesthesia combined continuous epidural anesthesia results in less anesthetic drug dosage and earlier recovery of respiratory function and consciousness than conventional general anesthesia with OPLAC laryngeal mask airway, and reduce the risk for the incidence of postoperative complications.