【摘要】 目的探讨不同麻醉方法用于老年患者上腹部手术的临床效果,为老年患者麻醉方法选择提供参考。方法选取2014年5月至2016年12月于商南县人民医院择期行上腹部手术的老年患者60例,按就诊顺序编号均分为A、B、C 3组,每组20例。其中A组为全身麻醉组,B组为全身麻醉复合硬膜外麻醉组,C组为硬膜外麻醉复合丙泊酚芬太尼清醒镇静组,比较3组患者的呼吸循环系统变化情况、血管活性药物应用情况、苏醒时间和ICU入住时间。结果 3组性别、年龄、体质量、美国麻醉医师协会(ASA)分级情况、手术时间、术前收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、呼气末二氧化碳分压(PET CO2)、心率(HR)比较差异均无统计学意义(P>0.05)。B、C组切皮时和切皮后30 min SBP、DBP较术前明显下降(P<0.05),且明显低于A组(P<0.05)。C组切皮时和切皮后30min的HR较术前明显下降(P<0.05),且明显低于A组(P<0.05)。C组各时段PETCO2[切皮时(39.5±2.4)mm Hg,切皮后30 min(39.8±2.0)mm Hg]均明显高于术前[(35.3±2.8)mm Hg],差异有统计学意义(P<0.05),该组呼吸抑制较为明显;B、C组苏醒时间[(12.5±7.1)min,(3.9±4.3)min]和ICU入住时间[(2.1±5.3)d,(0.5±2.6)d]均明显短于A组,差异有统计学意义(P<0.05),其中C组苏醒时间和ICU入住时间最短。结论硬膜外麻醉复合全身麻醉或丙泊酚镇静麻醉有助于老年患者上腹部手术后恢复,硬膜外麻醉复合全麻安全性高,具有推广应用价值。更多还原

【Abstract】 Objective To explore clinical effects of different anesthetic methods on senile patients who underwent abdominal surgery,so as to provide reference for the selection of anesthetic methods in senile patients. Methods Sixty patients who underwent abdominal surgery in the Shangluo County People’s Hospital from May 2014 to May 2016 were selected as research subjects,and they were divided into groups A,B and C in sequence of admission into hospital,each consisting of 20. Group A received general anesthesia,group B had anesthesia combined with epidural anesthesia and group C had epidural anesthesia combined with propofol fentanyl conscious sedation. Changes in respiratory and circulatory systems,application of vascular active drug,recovery of consciousness and length of ICU stay were compared between the 3 groups. Results There were no statistical differences in gender,age,weight,ASA classification,surgical time,pre-surgical systolic blood pressure(SBP),pre-surgical diastolic blood pressure(DBP),mean arterial pressure(MAP),end-tidal carbon dioxide partial pressure(PETCO2) and heart rate(HR),when comparisons were made between the3 groups(P > 0. 05). For groups B and C,SBP and DBP at incision and 30 minutes after incision decreased obviously as compared with those before surgery(P < 0. 05),and were considerably lower than those of group A(P < 0. 05). For group C,HR at incision and30 minutes after incision decreased obviously,as compared with that before surgery(P < 0. 05),and was significantly lower than that of group A(P < 0. 05). PETCO2 values of group C at various time points [(39. 5 ± 2. 4) mm Hg at incision,(39. 8 ± 2. 0) mm Hg 30 minutes after incision] were all significantly higher than those before surgery [(35. 3 ± 2. 8) mm Hg]. Statistical significance could be seen,when comparisons were made between the 3 groups(P < 0. 05). Respiratory inhibition could clearly be seen in group C. Conscious recovery time [(12. 5 ± 7. 1) min,(3. 9 ± 4. 3) min],length of ICU stay [(2. 1 ± 5. 3) d,(0. 5 ± 2. 6) d] for groups B and C were significantly shorter than those of group A(P < 0. 05),with statistical significance(P < 0. 05). Conscious recovery time and length of ICU stay for group C were the shortest. Conclusion Epidural anesthesia combined with general anesthesia or sedation with propofol would facilitate early recovery of senile patients after abdominal surgery,with good safety. For this reason,it is worth further clinical application.更多还原