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研究.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研究 　　【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(P 　　【关键词】 　　老年患者;腹腔镜胆囊切除术;硬膜外麻醉;全麻 　　 　　The study of the general anesthesia combined with epidural anesthesia for aged patients who underwent laparoscopic cholecystectomyJIANG Li-qing,LIU Can-fen.Hunan province Yiyang centen hospital anaesthesioligy room,Hunan,Yiyang,413000,China 　　【Abstract】 Objective To explore the effects of two different anesthesias for aged patients who underwent laparoscopic cholecystectomy.Methods 80 aged patients(age60)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