腰-硬联合麻醉用于老年前列腺电切术的体会  

The experience of combined spinal-epidural anesthesia in the old patients' the transurethral vaplrization of prostate

作　　者：王昌合 王成元 张传骧 

机构地区：[1]安徽省淮北矿工总医院集团麻醉科,235000 [2]安徽省淮北矿工总医院集团泌尿外科,235000

出　　处：《中国实用医药》2012年第16期45-46,共2页China Practical Medicine

摘　　要：目的观察腰-硬联合麻醉(CSEA)应用于老年人(≥80岁)前列腺电切术的临床麻醉效果。方法对50例老年人(≥80岁)前列腺电切术(TURP)患者在手术时选用CSEA,选择L2～L3或L3～L4穿刺点,到达硬膜外腔后用25 g腰穿针刺入蛛网膜下腔,见脑脊液流出后给予0.75%布比卡因1.5ml+25%葡萄糖注射液0.5 ml,同时硬膜外腔置管平卧,视平面情况取头高脚低位。比较麻醉前后BP、HR、SPO2等生命征体变化。记录麻醉后头痛、低血压、神经损伤等不良反应及并发症的发生率。结果全组患者麻醉效果满意,术中所有患者均有不同程度的BP下降,经扩容和应用麻黄碱后恢复平稳,术后并发症少。结论 CSEA起效快,阻滞效果完善,对循环、呼吸影响相对较小,可安全的应用于老年(≥80岁)高危患者经尿道前列腺电切手术(TURP)。[ Abstract] Objective To observe the clinical anesthesia effect of combined spinal-epidural anesthesia （CSEA） in the old patients＇ transurethral vaplrization of prostate. Methods Transurethral vaplrization of prostate were carried out in fifty old patients （ age≥80 years old）, to whom CSEA was operate. Puncture point was L2- L3 or L3- L4. 25 g waist wear needle was penetrated to subarachnoid space after reaching the epidural space. When the cerebrospinal fluid outflowed, 0.75% bupivacaine 1.5 ml plus 25% glucose O. 5ml was in- jected, meanwhile inserting a catheter. The patient was placed supine position, and the feet-down tilt position was adjust according to the block plane. The change of Anesthesia before and after BP,HR and SPO2was com- pared. The incidence of untoward effects and complications for example headache, hypotension, neurotrosis were recorded. Results All the patient got the satisfied anesthesia effect, during the operation BP decreased without exception, and after liquid dilatation and ephedrine was injected, it soon recovered. Little complication was recorded. Conclusion CSEA has rapid-action, perfect block effect, little affection on circulation and breath and it can safely be used in the aged （ ~ eighty years）highrisk patients＇ the transurethral vaplrization of prostate （TURP）.

关 键 词：腰-硬联合麻醉 老年(≥80岁) 高危 经尿道前列腺电切手术 

分 类 号：R614[医药卫生—麻醉学]