1、高齡前列腺增生患者經(jīng)尿道電切汽化術(shù)的麻醉         08-07-29 11:53:00     編輯：studa20          作者：張尚民丁輝舒展周文濤張震波【摘要】  目的：探討高齡高危前列腺增生患者經(jīng)尿道前列腺電切汽化切割術(shù)麻醉的方法及其安全性。方法：將80例7594歲的患者隨機分為腰硬聯(lián)合麻醉（combined spinalepidural anesthe

2、sia,CSEA）組和硬膜外麻醉（epidural anesthesia,EA）組，各40例，觀察各組麻醉起效時間，阻滯平面，鎮(zhèn)痛和肌松效果，局麻藥和靜脈輔助藥的用量及術(shù)中SAP,DAP,HR,RR,SpO2的變化，術(shù)后隨訪有無頭痛、惡心、嘔吐等副作用。結(jié)果：CSEA組比EA組麻醉起效快，鎮(zhèn)痛及肌松效果好。局麻藥和輔助藥用量少（P0.01）,術(shù)中血流動力學(xué)變化及術(shù)后隨訪兩組無顯著差異。結(jié)論：CSEA用于高齡高危前列腺增生患者經(jīng)尿道電切汽化術(shù)的麻醉安全有效，圍手術(shù)期個體化處理及麻醉操作和用藥是關(guān)鍵。 【關(guān)鍵詞】  前列腺增生前列腺切除術(shù)經(jīng)尿道麻醉高齡Anesthesia in tran

3、surethral electrovaporizationablation of prostate for aged patients with benign prostatic hyperplasia    【Abstract】bjective:To explore the method and safety of anesthesia adopted in transurethral electrovaporizationablation of prostate (TUEVAP) for aged patients with benign prostatic

4、hyperplasia.Methods:Eighty patients aged from 75 to 94 were randomly divided into two groups,each including 40 patients.One group received combined spinalepidural anesthesia (CSEA),and the other group received epidural anesthesia (EA).During anesthesia,the onset time,blocking plane,the quality of an

5、algesia and muscle relaxation,dose of local anesthetic and supplemental intravenous anesthetic,and the variation of SAP,DAP,HR,RR,SpO2 were compared.After operation,the side effect such as headache,postoperative nausea and vomiting were observed.Results:The onset time of sensory block was shorter in

6、 the CSEA group compared to that in the EA group,and the quality of analgesia and muscle relaxation was better in CSEA group.The dose of local anesthetic and supplemental intravenous anesthetic used in CSEA group was less than that used in EA group （P0.0）.There was no significant difference in the h

7、emodynamic changes and postoperative side effect between the two groups.Conclusions:CSEA can be safely and effectively applied to aged benign prostatic hyperplasia patients in transurethral electrovaporizationablation of the prostate.The key is individualized perioperative treatment and anesthetizin

8、g operation.    【Key words】  Prostatic hyperplasia;Prostatectomy,transurethral;Anesthesia;Aged    前列腺增生癥（benign prostatic hyperplasia, BPH）是老年男性的常見病，隨著年齡增長，其發(fā)病率逐漸上升，至85歲時，其發(fā)病率可達(dá)85%，切除前列腺增生部分是根本的解決方法。但對高齡（>75歲）合并嚴(yán)重心、腦、肺、肝、腎、糖尿病等的前列腺增生癥高危患者的手術(shù)麻醉，一直是臨床難點之一。2002年9月至

9、2006年8月我院收治了高齡高危BPH患者80例，隨機分為兩組，分別在硬膜外麻醉（epidural anesthesia,EA）和腰硬聯(lián)合麻醉（combined spinalpidural anesthesia,CSEA）下安全施行了經(jīng)尿道前列腺電切汽化切割術(shù)（transurethral electrovaporizationablation of the prostate, TUEVAP），比較了種麻醉方法用于TUEVAP的可行性與安全性，現(xiàn)報道如下。1  資料與方法1.1  臨床資料 80例患者7594歲，平均83歲，體重4886kg，ASA麻醉風(fēng)險評估級，進(jìn)

10、行性排尿困難622d，平均18d，34例有急性尿潴留史，52例有下尿路感染史。伴隨疾病有重度高血壓合并冠心病49例，心功能不全（、級）10例，房室傳導(dǎo)阻滯已安裝起搏器4例，需安裝臨時起搏器5例，冠心病冠狀動脈支架植入6例（最多植入3個支架），腦卒中后遺癥偏癱6例，腦梗死19例，糖尿病24例，腎功能不全18例，肝功能異常10例，貧血（血紅蛋白80100g/）15例，慢支肺氣腫6例。1.2  麻醉前處理  麻醉前個體化治療，心功能不全患者改善心功能在級以上，糖尿病患者控制血糖<7mmol/L，高血壓病患者血壓控制在140/90mm g以內(nèi)，糾正貧血，改善通氣功能，控制肺部及尿路感染，傳導(dǎo)阻滯的患者術(shù)前安置臨時起搏器，冠狀動脈植入支架者術(shù)前半月停用抗凝藥物，膀胱殘余尿量>500ml者，術(shù)前留置尿管。1.3  麻醉方法 1.4  統(tǒng)計學(xué)處理 數(shù)據(jù)以均數(shù)±標(biāo)準(zhǔn)差（±s)表示，計