硬膜外阻滞复合全麻在老年病人腹腔镜胆囊手术应用.doc

硬膜外阻滞复合全麻在老年病人腹腔镜胆囊手术应用 　【摘要】 目的 探讨硬膜外阻滞复合全麻在老年病人腹腔镜胆囊手术的应用。方法 ASAⅠ-Ⅱ级60～94岁胆囊手术患者120 例，分成单纯全麻组(Q组，n=60)，和硬膜外阻滞复合全麻组(Y组，n=60)。监测SBP、DBP、HR、PETCO2、SpO2、气道压，记录血流动力学参数，术中所用血管活性药病例数及麻醉药剂量。结果 Y组麻醉诱导、气管插管、切皮时、拔气管导管时SBP、DBP、HR低于Q组，血流动力学稳定，所用麻醉药少于Q组。结论 硬膜外阻滞能不同程度抑制麻醉手术所致的应激反应，硬膜外阻滞复合全麻在老年病人腹腔镜胆囊手术的应用是安全的、可行的、有益的。 【关键词】 硬膜外阻滞;老年病人;腹腔镜胆囊手术;血流动力学 　　Abstract Objective To discuss the application of combined general-epidural-anesthesia in laparoscopic cholecystectomy of senile patients.Methods 120 senile cases to be operated on of gallbladder at the age from 60 to 94 years old, whose ASA degrees were from Degree I to Degree II, were divided into 2 groups: Group Q (general anesthesia) and Group Y (combined general-epidural-anesthesia), 60 in each; SBP, DBP HR, PETCO2, SpO2 and airway pressure were monitored, the hemodynamic parameters, the case number with vasoactive drug administration in operation and anesthetic dosage were recorded.Result SBP, DBP and HR of the patients in Group Y with hemodynamic stability at the time of anesthesia induction, tracheal intubation, skin incision and tracheal catheter removing were lower than those of the patients in Group Q, and their anesthetic dosage was smaller than that in Group Q.Conclusions Epidural block can inhibit at certain degree the stress response to anesthesia; the application of combined general-epidural-anesthesia in laparoscopic cholecystectomy of senile patients is safe, feasible and useful. 　　KEYWORDS epidural block senile patients laparoscopic cholecystectomy hemodynamics 　　腹腔镜胆囊手术创伤小，手术时间短，术后恢复快，但是，老年病人各脏器系统功能减退，对麻醉手术耐受力降低，且多合并有心肺疾病，特别是合并有高血压病，麻醉手术刺激可引起大量儿茶酚胺释放及糖原异生，导致血压升高、心率加快、血流动力学剧烈波动及高血糖[1]。腹腔镜手术建立的二氧化碳气腹压对呼吸循环功能影响大，麻醉手术风险较大，术中有效控制不良应激反应，维持稳定的呼吸循环功能，保证氧供需平衡，术后让患者意识和自主生理功能尽早恢复，以减少并发症和意外情况的发生。本研究探讨硬膜外阻滞复合全麻在老年病人腹腔镜胆囊手术中应注意的。 　　1 资料与方法 　　1.1 病例选择 择期腹腔镜胆囊手术患者120例，ASAⅠ～Ⅱ级，年龄60～94岁，体重40～79公斤，均无硬膜外阻滞禁忌症，随机分成，全麻组(Q组)和硬膜外复合全麻组(Y组)，每组60例。两组患者性别、年龄、体重、血压等一般资料无统计学差异。 　　1.2 麻醉方法 术前伴发高血压疾病者，嘱口服降压药至术前一天。术前30分钟肌注