全麻复合硬膜外麻醉在老年患者腹腔镜胆囊切除术中临床探究.docVIP

全麻复合硬膜外麻醉在老年患者腹腔镜胆囊切除术中临床探究【摘要】 目的 探讨老年患者腹腔镜胆囊切除术用两种不同麻醉方法的临床效果。方法 择期行腹腔镜胆囊切除术的老年患者80例(年龄60岁),随机分为全麻组(A组)和全麻复合硬膜外麻醉组(B组),每组各40例。记录患者入室后(T?1)、诱导后(T?2)、插管后即刻(T?3)、CO?2气腹后(T?4)及气管拔管后即刻(T?5)各时点心率(HR)、收缩压(SBP)、舒张压(DBP)的变化;记录术毕患者苏醒时间、呼之睁眼时间和拔管时间;记录拔管后即刻、10 min、20 min、30 min伤口疼痛程度。结果 B组与A组相比:B组在T?3、T?4、T?5即刻的血流动力学较A组稳定,两组比较差异有统计学意义(P0.05),但苏醒期间患者发生烦躁反应A组(13例)远高于B组(5例),差异有统计学意义(P60)who underwent laparoscopic cholecystectomy(LC)were randomly divided into general anesthsia group(group A)and general anesthesia combined with epidural anesthesia group(group B),each groupfor 40 cases.The following data of two groups were recorded:the HR,SBP and DBP at the moment of entrance of surgery room(T?1),anesthesia induction(T?2),racheal intubation(T?3),establishment of pneumoperitoneum(T?4)and extubation(T?5),the time of post-oeprative analepsia,the time of open eyes when arousal and extubation;the degree of pain in the minute of extubation,10 min,20 min and 30 min after extubation.Results Group B compared with group A,the hemodynamics of B group was more stable in the instant of T?3,T?4,T?5,the difference between two groups was sinificant(P0.05).In group A(13 patients)had restlessness reaction,which was much more than B group(5 patients).The VAS grade of group B at each time point after extubation was much less than group A(P0.05),具有可比性。 1.2 麻醉方法 术前30 min肌肉注射阿托品0.5 mg,鲁米那钠0.1 g,入手术室开放外周静脉后,30 min内输入聚明胶肽500 ml。麻醉诱导:A组静脉开放后以芬太尼5~10 μg/kg,咪唑安定0.1~0.2 mg/kg,异丙酚1.0~2.0 mg/kg,维库溴胺0.08~0.12 mg/kg诱导插管,连接麻醉机控制呼吸,O2流量2 L/min,潮气量8~10 ml/kg,呼吸频率10~14次/min,吸呼比为1:2。B组静脉开放后硬膜外麻醉选择T8~9或T9~10间隙穿刺,头向置管,局麻药采用0.5%甲黄酸罗哌卡因,麻醉平面控制在T4以下,给试验剂量出现麻醉平面后开始全麻诱导,方法同A组。麻醉维持:两组均持续吸入1.0%~2.0%异氟醚,间断静脉注射芬太尼1.0~5.0 μg/kg、维库溴胺0.05 mg/kg维持麻醉,B组经硬膜外导管间断注入局麻药。CO2气腹充气速度为1.5 L/min,腹内压维持在10~15 mm Hg,术者清洗腹腔后停止吸入异氟醚。 1.3 观察指标及评分标准 记录患者入室后(T1)、诱导后(T2)、插管后即刻(T3)、CO2气腹后(T4)及气管拔管后即刻各时点SBP、DBP、HR;记录术毕患者苏醒时间、呼之睁眼时间和拔管时间;记录拔管后即刻、10 min、20 min、30 min伤口疼痛程度,采用视觉模拟评分(VAS评分),即0分为无痛,1~3分为轻痛,4~6分为中痛,≥7分为剧痛。 1.4 统计学方法 应用SPSS