Narcotrend监测下硬膜外阻滞复合全麻在老年病人腹部手术中的应用

目的比较Narcotrend监测下硬膜外阻滞复合全麻和单纯全麻用于老年病人腹部手术的临床效果,探讨老年腹部手术病人更安全合理的麻醉方式。方法 40例ASAⅡ～Ⅲ择期行腹部手术的老年病人,随机分为硬膜外阻滞复合全麻组(EGA)和单纯全麻组(GA),每组20例。两组全麻诱导用药为舒芬太尼0.4μg/kg、顺苯磺阿曲库铵0.15 mg/kg、依托咪酯0.2 mg/kg,气管插管后微泵持续输注丙泊酚、瑞芬太尼及间断静注顺苯磺阿曲库铵维持麻醉,术中行Narcotrend监测并使Narcotrend分级(NTS)维持在D0～D2之间。EGA组全麻诱导前先行硬膜外穿刺置管,注入试验剂量1.3%利多卡因3 ml,气管插管后硬膜外追加1.3%利多卡因6～8 ml,再以0.375%罗哌卡因5～8 ml/次维持硬膜外阻滞。术中监测血流动力学变化,术毕记录两组病人全麻维持用药量和病人睁眼时间、拔管时间及定位功能恢复时间等。结果 EGA组术中收缩压低于GA组(P<0.05);术中麻醉用药比较,EGA组丙泊酚及顺苯磺阿曲库铵用量少于GA组(P<0.05),EGA组瑞芬太尼用量明显少于GA组(P<0.01);恢复时间比较,EGA组病人睁眼时间、拔管时间、定位功能恢复时间均明显短于GA组(P<0.01);两组病人均无术中知晓发生。结论硬膜外阻滞复合全麻用于老年病人腹部手术血流动力学稳定,全麻药用量减少,病人恢复较快,是一种安全可行的麻醉方法,同时进行麻醉深度监测,有利于预防术中知晓。

The Application of Epidural Block Combined with General Anesthesia under Narcotrend Monitoring in Elderly Patients Undergoing Abdominal Surgery

Objective To evaluate the efficacy of epidural block combined with general anesthesia under Narcotrend monitoring in elderly patients undergoing abdominal surgery. Methods Forty ASA II ～Ⅲ elder- ly patients, scheduled for elective abdominal surgery, were divided randomly into two groups （n = 20） ： Group EGA received epidural block combined with general anesthesia and group GA received pure general anesthesia. In both groups general anesthesia was induced with sufentanyl, cisatracurium, propofol, and maintained using continuous infusion of propofol and remifentanyl and intermittent bolus of cisatracurium. Anesthesia depth were measured with Narcotrend monitoring and the Narcotrend stage（NTS） was maintained between DO to D2 during surgery. In group EGA, the epidural catheter was placed at T12-9 interspace before induction of general anes- thesia and correct placement was confirmed by a test dose of 1.3% lidocaine 3 mL Then a dose of 1.3% lido- caine 6 -8 ml was administered after endotracheal intubation followed by an intermittent bolus of 0.375% ropi- vacaine 5 -8 ml according to specific conditions to perform epidural block. Hemodynamics, recovery time, postoperative restlessness and general anesthetic dosage were recorded. Results In the group EGA , SBP during operation was decreased significantly compared with group GA （ P 〈 0.05 ）. The requirements of propofoland cisatracurium in group EGA were less than group GA （ P 〈 0.05 ） and significant reduction was also ob- served on the requirement of remifentanil in group EGA （P 〈 0.01 ）. Recovery time was shorter in the group EGA than in the group GA（P 〈 0.01 ）, Intraoperative awareness was not found in both groups. Conclusions Epidural block combined with general anesthesia in elderly patients undergoing abdominal surgery can stabilize the hemodynamics, reduce the requirement of anesthetic dosage and make postanesthesia recovery faster, which can be applied safely and effectively, and the monitoring of anesthesia depth is helpful to preventing awareness during the combined anesthesia.