高龄高危患者下腹部手术Proseal喉罩通气静脉复合硬膜外麻醉与静吸复合气管内麻醉的比较  

Lower abdominal surgery in elder patients comparision of epidural block combined intravenous anesthesia with the use of Proseal mask ventilation and intravenous inhaled endotracheal anesthesia

作　　者：王晓娜[1] 苗鲁民[1] 王国林[1] 于泳浩[1] 

机构地区：[1]天津医科大学总医院麻醉科,天津300052

出　　处：《天津医科大学学报》2010年第3期525-527,533,共4页Journal of Tianjin Medical University

摘　　要：目的:探讨Proseal喉罩(PLMA)复合硬膜外麻醉在80岁以上高危患者下腹部手术中应用的安全性和可行性。方法:30例ASAⅡ～Ⅲ级接受直肠癌、乙状结肠癌手术的高龄患者,年龄80～91岁,随机分为全麻组(GA组)和硬膜外阻滞复合PLMA组(EL组)。观察两组的麻醉效果、血流动力学变化、不良反应和术后并发症。结果:GA组插管后、切皮时血压、心率均较EL组明显增高,探查操作及拔管后收缩压较EL组有明显增高,拔管后心率明显高于EL组。术中芬太尼、丙泊酚用量GA组明显多于EL组。安静拔管(罩)者EL组高于GA组。术后咽喉痛者GA组高于EL组。结论:Proseal喉罩复合硬膜外麻醉用于高危高龄患者下腹部手术,应激反应小,全麻药用量和术后不良反应少,病人恢复快。Objective： To study the safety and efficacy of epidural anesthesia combined with Proseal laryngeal mask airway in elder critically ill patients undergoing lower abdomen surgeries. Methods： Thirty eider patients（80-91 years old）, ASA I1 or m, scheduled for selective surgeries（rectal cancer, carcinoma of sigmoid）, were allocated randomly to either endotracheal intubation general anesthesia group （GA, n= 15） or epidural anesthesia combined with Proseal mask group （EL, n=lS）. SBP, DBP, HR and anesthetic effect were monitored and adverse effect and complications were recorded. Results： In group GA, SBP, DBP and HR were significantly higher than those in group EL at 1 minute after intubation, and skin incision; SBP and HR were significantly higher than those in group EL at exploration and 1 minute after extubation, and HR were higher than EL group at 1 minute after extubation. Propofol and fentanyl dosage in group GA were significant greater than those in group EL during surgeries. Group GA had higher incidence of body movement and coughing before extubation （P〈0.01）, and higher incidence of postoperative sore throat than those of group EL（P〈0.05）. Conclusion： Epidural combined intravenous anesthesia with Proseal laryngeal mask airway in eider critically condition patients undergoing lower abdomen surgeries is effective and safe, and better than endotracheal intubation sevoflurane inhaled combined intravenous anesthesia in keeping stable hemodynamics and producing less stress responses with smooth recovery from anesthesia.

关 键 词：麻醉 硬膜外 老年 PROSEAL喉罩 应激 腹部外科学 

分 类 号：R614[医药卫生—麻醉学]