硬膜外阻滞对老年高血压患者腹部手术后并发症的影响  

Effects of epidural block on the incidence of postoperative complications in elderly with hypertension after laparotomy

作　　者：周岩[1] 王东信[1] 

机构地区：[1]北京大学第一医院麻醉科,100034

出　　处：《临床麻醉学杂志》2014年第10期968-972,共5页Journal of Clinical Anesthesiology

摘　　要：目的观察硬膜外阻滞对老年高血压患者腹部手术后并发症的影响。方法合并高血压并接受规范抗高血压治疗、拟在全麻下行开腹手术的老年患者146例,年龄65~80岁,随机均分为全麻组（A组）和硬膜外复合全麻组（B组）,两组术后均采用硬膜外镇痛。记录两组患者麻醉时间、麻醉药用量、BIS值、手术时间、手术种类、术中液体出入量、术中出现低血压时间、麻黄碱和去氧肾上腺素给药次数、术中发生知晓例数。观察术后短暂脑缺血发作、脑卒中、心功能不全、急性冠脉综合征、心律失常、肺部感染、肾功能受损、胃肠道并发症发生率;记录术后不良反应、首次排气时间、住院天数、术后30d全因死亡率。结果两组患者麻醉时间、麻醉药用量、BIS值、手术时间、手术种类、液体出入量、术中出现低血压时间、去氧肾上腺素给药次数差异均无统计学意义。与A组比较,B组麻黄碱给药次数、术后心功能不全发生率明显增加（P〈0.05或P〈0.01）,术后肺部感染发生率明显降低（P〈0.05）,术后住院天数明显延长（P〈0.05）。两组患者均无术中知晓及术后30d全因死亡发生。结论老年高血压患者行腹部手术时采用硬膜外复合全麻并不比单纯全麻更有优势。Objective To compare the effects of two regimens of anesthesia management on the postoperative complications in elderly with hypertension after laparotomy.Methods One hundred and forty-six gerontal patients with hypertension and having received standard antihypertensive treatment,aged 65-80 yr,were scheduled for laparotomy and equally randomized into two groups：general anesthesia group（group A）and the combination of general and epidural anesthesia group（group B）.All the patients received postoperative epidural analgesia.The length of anesthesia,anesthesia dose,BIS value,operation time,types of operation,liquid intake and output volume,duration of perioperative hypotention,administration frequency of ephedrine and phenylephrine,and cases of perioperative awareness were recorded.The occurrence of transient cerebral ischemia,stroke,cardiac dysfunction,acute coronary syndrome,arrhythmia,pulmonary infection,impaired renal function,and incidence of gastrointestinal complications were observed.Simultaneously,the postoperative adverse effects,first evacuating time,days of hospitalization,and postoperative 30 day all-cause mortality were also recorded.Results There was no difference in the length of anesthesia,anesthesia dose,BIS value,operation time,types of operation,liquid intake and output volume,duration of perioperative hypotention,and administration frequency of phenylephrine in the two groups.Compared with the group A,the administration frequency of perioperative ephedrine and the incidence of cardiac dysfunction were significantly higher in the group B（P〈0.05）,while the incidence of postoperative pulmonary infection was significantly lower and the length of hospitalization was longer in the group B（P〈0.05）.No intraoperative awareness and postoperative 30 day all-cause death occurred in the two groups.Conclusion General combined epidural anesthesia is not superior than general anesthesia alone during the laparotomy for elderly with hypertension.

关 键 词：老年 高血压 开腹手术 硬膜外阻滞 术后并发症 

分 类 号：R614[医药卫生—麻醉学]