硬膜外阻滞用于80岁以上伴有呼吸系统疾患行开腹单纯胆囊切除术的临床观察  

Clinical observation on epidural block in patients with respiratory system diseases aged over 80 who underwent simple cholecystectomy

作　　者：裘剑波[1] 张毅[1] 罗义骏[1] 陆叶兰[1] 

机构地区：[1]解放军第113医院麻醉科,浙江宁波315040

出　　处：《临床军医杂志》2011年第5期861-862,共2页Clinical Journal of Medical Officers

摘　　要：目的观察硬膜外阻滞用于80岁以上伴有呼吸系统疾患行开腹单纯胆囊切除术的有效性和安全性。方法将60例患者随机分为硬膜外组和全麻插管组各30例。比较两组的麻醉效果,不良反应的发生率及住院时间。结果 30例硬膜外阻滞组患者均获得了满意的麻醉效果,无一例改气管插管全麻;9例术中有严重的牵拉反射和不适,辅助适量芬太尼后缓解。SpO2﹤95%5例,一过性呼吸抑制2例,经麻醉机进行短暂辅助呼吸后恢复正常,术中和术毕未见呼吸系统疾患发作,平均住院时间(11±2)d。术后无一例行机械通气,无一例肺部感染。30例全麻组麻醉效果均满意,术中发生支气管痉挛2例,术后苏醒期发生哮喘5例;术毕带气管导管回病房12例,其中转ICU行机械通气5例,术后肺部感染2例,平均住院时间(18±3)d。两者比较差异有统计学意义(P<0.05)。结论硬膜外阻滞用于80岁以上伴有呼吸系统疾患行开腹单纯胆囊切除术是有效和安全的,和气管插管全麻相比,具有减少或避免了呼吸系统疾患的发作,缩短了住院时间。Objective To observe the efficacy and safety of epidural block in patients with respiratory system diseases aged over 80 who underwent simple cholecystectomy. Methods 60 cases were randomly divided into epidural block group and general anesthesia intubation group with 30 cases each.Anesthetic effect,hospital stays and the incidence of adverse reactions in two groups were observed and compared. Results 30 cases with epidural block treatment achieved the satisfactory anesthetic effect,none of all cases was changed to general anesthesia intubation.9 cases had pulling reaction of viscu and discomfortableness during operation and treated by Fentanyl.There were 5 cases with SpO295%,2 cases with transient respiratory depression and treated by using anesthesia machine for assisted respiration.No respiratory system diseases occurred during operation,the average hospital stays was（11±2）d.There was no case of mechanical ventilation and pulmonary infection.However,30 cases with general anesthesia intubation treatment also achieved the satisfactory anesthetic effect.There were 2 cases of bronchospasm during operation,5 cases of asthma in recovery period,12 cases went back to the ward with tracheal catheter,5 cases were changed to mechanical ventilation in ICU and 2 cases with postoperative pulmonary infection,the average hospital stays was（18±3）d.The difference between two groups had statistic difference（P0.05）. Conclusion Epidural block is effective and safe in treating patients with respiratory system diseases aged over 80 who underwent simple cholecystectomy.It can reduce or avoid the attacks of respiratory system diseases and shorten hospital stays.

关 键 词：硬膜外阻滞 高龄 呼吸系统疾患 胆囊切除术 

分 类 号：R614.2[医药卫生—麻醉学]