摘要
目的探讨连续腰麻(CSA)用于高危老年病人下腹部或下肢手术的可行性。方法64 例拟行下腹部或下肢手术的老年病人,年龄70-101岁,ASAⅢ或Ⅳ级,随机分为2组,硬膜外麻醉组(EA组)、CSA组,每组32例。EA组行硬膜外麻醉,CSA组行CSA。记录两组麻醉平面满意时的时间,以改良Bromage评分法评定下肢运动神经阻滞的程度,于动脉穿刺完毕时(T0,基础值)、麻醉平面满意时(T1)、切皮后1 h(T2)、术毕(T3)抽取动脉血,测定血浆乳酸浓度,监测平均动脉压(MAP)、心率(HR),记录两组病人辅用麻黄碱、氟芬合剂的情况,观察下肢运动功能恢复情况。结果与基础值比较,CSA组T1-3时MAP、HR变化无统计学意义(P>0.05);EA组T1时MAP、HR下降(P<0.05)。T0-2 期间,EA组有31例(98%)病人需辅用麻黄碱,CSA组有5例(15%)病人需辅用麻黄碱,两组比较差异有统计学意义(P<0.01),EA组麻黄碱用量[(34.5±3.1)mg]高于CSA组[(4.3±0.5)mg](P< 0.01)。与EA组比较,CSA组麻醉起效时间明显及运动功能恢复时间缩短(P<0.05);CSA组Bromage 评分高于EA组(P<0.05);EA组有17例(51%)病人术中需辅用氟芬合剂,CSA组有7例(20%)病人需辅用氟芬合剂,两组比较差异有统计学意义(P<0.05)。血浆乳酸浓度:EA组T1-3时均高于CSA 组(P<0.05);EA组在T1-3时均高于基础值(P<0.05)。CSA组均?
Objective To evaluate the feasibility and safety of using continuous spinal anesthesia (CSA) in high risk elderly patients undergoing lower abdominal or lower extremity surgery. Methods Sixty-four ASA III or IV patients aged 70-101 yr weighing 38-55 kg undergoing lower abdominal or lower extremity surgery were randomized to receive epidural anesthesia (EA) (n = 32) or CSA ( n = 32). The patients were complicated with cerebral embolism and/or hypertension, coronary artery disease and/or COPD and/or diabetes mellitus. The patients were unpremedicated. EA was performed at I2.3 or L1.2. A test dose of 2 ml of 2% lidocaine was given. When no signs of spinal block was observed, 1 % ropivacaine was given in small increments until the block height reached T6-8 . CSA was performed at L3,4 using Spinocath (B. Braun). A 2-cm catheter segment was left in subarachnoid space. 0.5% bupivacaine was given in 0.5 ml increments every 3 min until satisfactory block level was reached. The onset time of anesthesia was recorded. The degree of motor block was assessed using modified Bromage scale. Arterial blood samples were obtained before anesthesia (T0 , baseline), when satisfactory block level was reached ( T1), 1 h after skin incision (T2) and at the end of operation (T3) for determination of lactate concentration. The amount of ephedrine and innovar ( droperidol-fentanyl mixture) used during operation and the recovery of motor function of lower extremities were also recorded. Results The demographic data including sex, age, height, body weight, ASA physical status and types of operation were not significantly different between the two groups. BP and HR were significantly decreased after anesthesia as compared to the baseline values at T0 in group EA, whereas in CSA group there were no significant changes in BP and HR after anesthesia. Significantly more patients received ephedrine in EA group (98% ) than in CSA group (15%) and the mean dose of ephedrine was significantly higher in EA group [(34.5±3.1) mg] than in CSA group [(4.3±0.5) mg ]. The onset of block was significantly faster in CSA group than in EA group. Motor blockade was less intense in EA group as assessed by modified Bromage scale. Analgesia was more satisfactory in CSA group and less patients received innovar during operation in CSA group (20% ) than in EA group (51% ). The recovery of motor function of lower extremities was faster in CSA group than in EA group. Blood lactate was significantly higher at T1 , T2 , T3 in EA group than in CSA group. No late complications related to CSA was observed. Conclusion CSA is safe and effective and provides better analgesia with better hemodynamic stability and faster onset of block than EA in elderly patients.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2005年第4期263-266,共4页
Chinese Journal of Anesthesiology
