老年患者下肢手术椎管内麻醉不同方法的比较  

A comparison of different intravertebral anesthetic techniques in elderly patients undergoing lower extremity surgery

作　　者：邱燕文 周泽钢 何志文 杨戟 

机构地区：[1]四川省邛崃市第三人民医院麻醉科,611530

出　　处：《实用医学杂志》2008年第8期1330-1332,共3页The Journal of Practical Medicine

摘　　要：目的:比较连续硬膜外麻醉(CEA)、腰硬联合麻醉(CESA)、连续腰麻(CSA)用于高龄患者下肢手术的临床效果。方法:选择择期手术老年患者60例,年龄65～80岁,ASAⅠ～Ⅲ级,分成CEA组、CESA组、CSA组,每组20例。CEA组选择T11～12硬膜外向尾置管3～4cm,仰卧后2%利多卡因3mL作为试探量,继以0.5%左旋布比卡因4～6mL。CESA组和CSA组选择L2～3蛛网膜下腔穿刺,分别予0.5%左旋布比卡因2、1.2mL。CESA组硬膜外向头端置管3～4cm,CSA组蛛网膜下隙置入Spinocath管1～2cm。3组麻醉平面控制在T9以下,观察并记录麻醉前、麻醉后最低值、麻醉后30min、麻醉后60min、术毕的MAP、HR、SpO2。记录3组的麻醉效果及不良反应。结果:3组MAP在30min内较基础值明显下降(P<0.05),CSA组下降又明显小于其他两组(P<0.05)。HR、SpO2差异无显著性,CESA和CSA组在麻醉起效时间、维持时间、Bromage运动阻滞分级等方面相似,明显优于CEA组。CEA和CESA组在围手术期的并发症及副作用多于CSA组(P<0.05)。结论:CSA与CESA的麻醉效果相似,CSA较CESA和CEA的副作用更少,更适合于老年患者的麻醉。Objective To evaluate the efficacy and safety of different intravertebral anesthetic techniques in elderly patients undergoing lower extremity surgery. Methods Sixty ASA Ⅰ ～ Ⅱ patients ages 65～80yr undergoing lower extremity surgery were assigned to receive continuous epidural anesthesia （CEA group,n=20）, combined spinal-epidural anesthesia （CSEA group, n=20）, or continuous spinal anesthesia （CSA group,n=20）. The anesthetic plane was under the level of Tg. MAP, HR, and SpO2 at baseline value, the lowest level following anesthesia, 30 min after anesthesia, 60 min after anesthesia, and completion of anesthesia were measured in the three groups. The anesthetic efficacy and adverse events were recorded. Results As compared with the baseline, MAP decreased significantly within 30 min of anesthesia in all the groups（P 〈 0.05） and its level was obviously lower in the patients receiving CSEA or CEA than in those receiving CSA（P 〈 0.05）. There were no differences in HR and SpO2 among all the groups. CSEA was similar with CSA in the onset of action, duration of blockade, and Bromage score and both of them were superior to CEA. More complications and adverse events occurred in the patients receiving CEA or CSEA than in those receiving CSA. Conclusions CSA is similar with CSEA in the anesthetic efficacy and has fewer adverse events than CSEA and CEA, which is more suitable for elderly patients.

关 键 词：麻醉 硬膜外 腰硬联合麻醉 连续腰麻 左旋布比卡因 

分 类 号：R614[医药卫生—麻醉学]