【作者】 钟瑛； 谭宪湖； 谭冠先； 刘丽；

【机构】 广西钦州市第二人民医院麻醉科； 广西医科大学第一附属医院麻醉科；

【摘要】 目的:观察不同剂量布比卡因脊麻联合硬膜外麻醉在老年人经尿道前列腺电切术的麻醉效果及血流动力学影响,探讨布比卡因脊-硬联合麻醉行老年人经尿道前列腺电切术的安全性和适宜剂量,为临床应用提供依据。方法选择90例年龄≥65岁择期行TURP的老年BPH患者,随机分为三组,每组30例,均选择L_2-3进行穿刺,蛛网膜下腔注入局麻药后向头端置硬膜外导管4.0cm,脊麻用药:Ⅰ组0.5%布比卡因5mg（1ml）;Ⅱ组0.5%布比卡因7.5mg（1.5ml）;Ⅲ组0.5%布比卡因10mg（2ml）。根据麻醉平面决定硬膜外用药。观察指标:感觉阻滞出现时间、达最高平面时间、最高阻滞平面;运动阻滞出现时间、达最大运动阻滞时间、改良Bromage分级及脊麻用药后5min、10min、15min、20min、30min和40min血压、心率变化;记录脊麻后低血压、心动过缓、呼吸抑制、寒战、恶心、呕吐、术后头痛等副作用发生率。结果各组患者感觉阻滞起效时间、平面固定时间差异无统计学意义（P>0.05）,最高阻滞平面Ⅱ组、Ⅲ组与Ⅰ组比较差异均有统计学意义（P<0.05）,Ⅱ组与Ⅲ组比较差异无统计学意义（P>0.05）;运动阻滞起效时间Ⅱ组、Ⅲ组与Ⅰ组比较差异均有统计学意义（P<0.05）,Ⅱ组与Ⅲ组比较差异无统计学意义（P>0.05）;达最大运动阻滞时间各组比较均有统计学意义（P<0.05）,Ⅰ组>Ⅱ组>Ⅲ组;各组患者最大Bromage分级均集中在2～3级;麻醉效果评价:Ⅰ组:优80%,良20%;Ⅱ组:优95%,良5%;Ⅲ组:优100%,总优良率100%。麻醉后各组患者SBP、DBP、HR均有不同程度下降,但Ⅰ组、Ⅱ组与基础值比较差异无统计学意义（P>0.05）,Ⅲ组患者在脊麻后15min、20min、30min时点SBP显著下降（P<0.05）,但DBP、HR与基础值比较差异无统计学意义（P>0.05）。各组患者麻醉后各时点SBP、DBP、HR组间比较差异无统计学意义（P>0.05）。低血压发生率Ⅲ组>Ⅱ组>Ⅰ组,但三组低血压发生率比较无统计学意义（P>0.05）;心动过缓发生率Ⅲ组>Ⅱ组>Ⅰ组,Ⅲ组与Ⅰ组比较差异有统计学意义（P<0.05）,Ⅱ组与Ⅰ组、Ⅲ组比较差异无统计学意义（P>0.05）;三组寒战发生率差异无统计学意义（P>0.05）。无明显的呼吸抑制、恶心、呕吐及术后头痛等副作用发生。结论脊-硬联合麻醉起效快、成功率高、效果确切、局麻药用量少,是老年人TURP手术较理想的麻醉方法。0.5%等比重布比卡因7.5mg脊麻联合硬膜外麻醉行老年人TURP麻醉效果满意、血流动力学影响小、不良反应少,是较适宜的脊麻剂量。更多还原

【Abstract】 Objectives To investigate the feasibility and the best dose of bupivacaine combined spinal-epidural anesthesia（CSEA） on transurethral resection of prostate（TURP） in the elderly by observed the effective and hemodynamic respondence on combined spinal-epidural anesthesia with different dose of bupivacaine. Methods Sixty ASA physical stadusⅠ-Ⅲpatients,aged≥65 years who undergone transurethral resection of prostate to apply combined spinal-epidural anesthesia were divided into three groups randomly. Every group involved 20 patients.CSEA of all patients was performed at the L2-3 interspace with spinal-epidural needle.Epidural catheter place 4.0cm faced capitulum after local anesthetic was injected into subarachnoid space.GroupⅠreceived 5mg（1ml） of bupivacaine 0.5%for spinal anesthesia;GroupⅡreceived 7.5mg（1.5ml） of bupivacaine 0.5%for spinal anesthesia;GroupⅢreceived 10mg（2ml） of bupivacaine 0.5%for spinal anesthesia.If analgesia didn’t reach T₁₀ within 20mins,supplemental lidocaine 2%was injected into epidural space.Observing and recording:the time of sensory block occur;the time of sensory block reaching maximum plane;the maximum plane of sensory block;the time of motor block occur; the time of motor block reaching maximum and evaluating motor block by modified bromage scale;the change of blood pressure and heart rate of the 5min,10min,15min,20min,30min and 40min after intrathecal local anesthetic administration;the incidence of hypotension,bradycardia,respiratory depression,shivering,nausea and vomit,postdural puncture headache（PDPH）,et al. Results No significant differences among three groups of the time of sensory block occur and sensory block reaching maximum plane were observed（P>0.05）.There is significant differences between groupⅡ, groupⅢand groupⅠof the maximum plane of sensory block（p<0.05）,but no significant differences groupⅢand groupⅡ（P>0.05）.There is significant differences between groupⅡ,groupⅢand groupⅠof the maximum plane of sensory block（p<0.05）,but no significant differences GroupⅢand GroupⅡ（P>0.05）.There is significant differences among three groups of the time of motor block reaching maximum （p<0.05） and GroupⅠis the slowliest.Bromage scale of three groups concentrated on 2～3 levels. Effective evaluating:well 80%,good 20%in group I;well 95%,good 5%in groupⅡ;well 100%in groupⅢ.Three groups of SBP,DBP,and HR all decreased with different degrees after anesthesia.But no significant differences compaired groupⅠand groupⅡwith it’s base（P>0.05）.There is significant differences of SBP at 15min、20min、30min after anesthesia in groupⅢ（p<0.05）,but no significant differences of DBP and HR in groupⅢas it’s base（P>0.05）.However,no significant differences among three groups of hemodynamic respondence were observed（P>0.05）.The incidence of hypotension is groupⅢ>groupⅡ>groupⅠ,but no significant differences among three groups（P>0.05）.The incidence of bradycardia is groupⅢ>groupⅡ>groupⅠ,but There is significant differences between groupⅠand groupⅢ（p<0.05） and no significant differences between groupⅠ,groupⅢand groupⅡ（P>0.05）.No significant differences between three groups of shivering were observed（P>0.05）.No happened significant respiratory depression,nausea and vomit,PDPH,et al. Conclusion Combined spinal-epidural anesthesia is the ideal method of anesthesia on TURP in the elderly,for effecting faster,high achievement ratio,sacral nervey blocked consummately,sure effect,low dosage of local anesthetic.Combined spinal-epidural anesthesia with 0.5%bupivacaine 1.5ml（7.5mg） is the best dose on TURP in the elderly patients,which the effective is satisfied,slight hemodynamic respondence, less side effect.更多还原