摘要
目的观察硬膜外联合静脉快通道麻醉用于老年患者上腹部手术对麻醉恢复的影响。方法择期行小切口胆囊切除术老年患者68例,随机分为全凭静脉麻醉(A)、硬膜外联合快通道麻醉(B)(每组34例)。两组麻醉诱导均采用咪唑安定0.03mg/kg、瑞芬太尼2μg/kg、丙泊酚2mg/kg,维库溴铵8-10μg/(kg.min)诱导气管插管,全麻维持用微泵注射瑞芬太尼0.05-2μg/(kg.min)、丙泊酚60-120μg/(kg.min)、间断追加维库溴铵。B组诱导前先选T7-8-T8-9间隙硬膜外置管注入0.5%利多卡因3ml试验量诱导出现阻滞平面,术中以硬膜外镇痛为主。麻醉苏醒采用Steward评分方法,10分钟内≥4分送回病房,否则送入PACU或ICU,同时记录术中觉醒、术后躁动、麻醉药用量。结果两组病人麻醉效果均满意;Steward评分≥4分者B组明显高于A组(P<0.05)。结论硬膜外联合静脉快通道麻醉可让老年上腹部手术患者术后尽早苏醒,减少进入PACU或ICU几率。
Objective To investigate the effect of epidural block combined with intravenous fast - tracking anesthesia on recovery in patients undergoing upper abdominal surgery. Methods Sixty - eight patients were randomly divided into two groups： total intravenous anesthesia group （A） and epidural combined with intravenous fast - tracking anesthesia group （ B ）. All patients were induced intravenously with midazolam 0.03mg/kg, remifentanil 2μg/kg, propofol 2mg/kg and vecuronium 0. 1mg/kg. Anesthesia was maintained with propofol 60 - 120μg/（ kg . min ）, remifentanil 0. 05 - 2μg,/ （ kg . min ） and vecuronium 8 - 10μg/（ kg.min ） intravenously via pump in both groups. Epidural block was performed at T7-8 -T8-9 and an epidural catheter was placed and 0. 5% lidocaine 3ml was given before induction of general anesthesia and during operation the local anesthetics were infused punctually in group B. The patients were scored by using Steward postanesthesia recovery score system after operation finished. Patients with score of 4 or higher within 10min were transferred to the ward,otherwise recovered in PACU or ICU until they met the above discharge criteria and were transferred to the ward. And intraoperative awareness,postoperative restlessness and anesthetic dosage were recorded. Results Two groups could provide same anes- thesia. Patients with score of 4 or higher in group B were significantly higher than that in group A within 10min after operation（ P 〈 0. 01 ）. Conclusion Epidural block combined with intravenous fast - tracking anesthesia in elderly patients undergoing upper abdominal surgery could get a rapid recovery and reduce the opportunity of the patients were transferred to PACU or ICU.
出处
《宁夏医学杂志》
CAS
2008年第5期423-425,共3页
Ningxia Medical Journal
关键词
上腹部手术
麻醉
快通道
硬膜外
老年人
Abdominal surgery
Anesthesia
Fast - tracking
Epidural
Elderly
