两种不同麻醉方法用于老年肛肠疾病患者痔上黏膜环形切除钉合术的临床观察  

Comparison of two different anesthesia methods for the procedure for prolapse and hemorrhoids in elderly patients with anorectal diseases

作　　者：魏滨[1] 宗亚楠 敦元莉[1] 徐懋[1] 连天厚 Wei Bin;Zong Yanan;Dun Yuanli;Xu Mao;Lian Tianhou(Department of Anesthesiology,Peking University Third Hospital,Beijing 100191,China;Department of General Surgery,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院麻醉科,100191 [2]北京大学第三医院普通外科,100191

出　　处：《中华老年医学杂志》2019年第9期1033-1036,共4页Chinese Journal of Geriatrics

摘　　要：目的比较蛛网膜下腔麻醉(SA)和硬膜外麻醉(EA)用于老年良性肛肠疾病患者痔上黏膜环形切除钉合术(PPH)的麻醉效果。方法回顾性分析北京大学第三医院2018年3—8月收治的诊断为良性肛肠疾病接受PPH的老年患者60例,依据麻醉方法分为SA组和EA组,每组30例。采用针刺法测试感觉阻滞平面,采用改良Bromage评分法评定运动阻滞情况,比较两组患者麻醉效果、手术时间、失血量、不良事件和住院时间的差异。结果两组患者最高感觉阻滞平面相似,差异无统计学意义(P>0.05)。EA组患者感觉阻滞起效时间中位数(四分位间距)为270.0(66.3)s,长于SA组25.5(14.3)s;改良Bromage评分EA组1.0(1.0)分,低于SA组2.0(1.0)分(Z=6.657、-1.685,均P=0.000)。EA组患者较SA组患者发生低血压、恶心呕吐和尿潴留的风险更低,差异均具有统计学意义(χ^2=6.405、4.286、4.403,P=0.011、0.038、0.044)。两组患者的麻醉效果、手术时间、失血量和住院时间的差异均无统计学意义(均P>0.05)。结论EA可为接受PPH的老年患者提供完善的麻醉和镇痛,具有肢体运动恢复快、不良反应低的优势,可作为替代SA的有效麻醉方法,是良性肛肠疾病推广加速康复外科手术的适宜麻醉方法。Objective To compare the anesthetic effects of subarachnoid anesthesia(SA)and epidural anesthesia(EA)for the procedure for prolapse and hemorrhoids(PPH)in elderly patients with benign anorectal diseases.Methods A retrospective analysis was conducted in 60 patients with benign anorectal diseases admitted to Peking University Third Hospital from March to August 2018 and undergoing PPH.According to anesthesia methods,patients were divided into the SA group and the EA group(n=30 each).The level of sensory block was tested by acupuncture,and the degree of motor block was assessed by revised Bromage score.The anesthesia effect,operation time,blood loss,adverse events and hospitalization time were compared between the two groups.Results The highest level of sensory block was similar between the two groups without significant difference(P>0.05).The median onset time of sensory block was longer in the EA group[270.0 s(interquartile range,66.3 s)]than in the SA group[25.5 s(interquartile range,14.3 s)].The revised Bromage score was lower in the EA group than in the SA group[1.0(interquartile range,1.0)vs.2.0(interquartile range,1.0),Z=6.657,-1.685,both P=0.000].The risks of hypotension,nausea and vomiting,and urinary retention were lower in the EA group than in the SA group(χ^2=6.405,4.286 and 4.403,P=0.011,0.038 and 0.044).There were no significant differences in anesthetic effect,operation time,blood loss and hospitalization time between the two groups(all P>0.05).Conclusions EA can provide a perfect anesthesia and analgesic effect for elderly patients receiving PPH,with the advantages of rapid recovery of limb movement and low adverse events.As a substitute for SA,EA is a suitable anesthesia method for promoting the enhanced recovery after surgery(ERAS)in patients with benign anorectal diseases.

关 键 词：麻醉和镇痛 麻醉 硬膜外 痔 

分 类 号：R614[医药卫生—麻醉学]