高齡前列腺增生患者經(jīng)尿道電切汽化術(shù)的麻醉.doc

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1、高齡前列腺增生患者經(jīng)尿道電切汽化術(shù)的麻醉作者：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75～94歲的患者隨機(jī)分為腰硬聯(lián)合麻醉（combinedspinalepiduralanesthesia,CSEA）組和硬膜外麻醉（epiduralanesthesia,EA）組，各40例，觀察各組麻醉起效時(shí)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(wú)頭痛、惡心、嘔吐等副作用。結(jié)果：CSEA組

2、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（P＜0.01）,術(shù)中血流動(dòng)力學(xué)變化及術(shù)后隨訪兩組無(wú)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(gè)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　　Anesthesiaintransurethralelectrovaporizationablationofprostateforagedpatientswithbenignprostatichyperplasia　　【Abstract】Ｏbjective:T

3、oexplorethemethodandsafetyofanesthesiaadoptedintransurethralelectrovaporizationablationofprostate(TUEVAP)foragedpatientswithbenignprostatichyperplasia.Methods:Eightypatientsagedfrom75to94wererandomlydividedintotwogroups,eachincluding40patients.Onegroupreceivedcombinedspinale

4、piduralanesthesia(CSEA),andtheothergroupreceivedepiduralanesthesia(EA).Duringanesthesia,theonsettime,blockingplane,thequalityofanalgesiaandmusclerelaxation,doseoflocalanestheticandsupplementalintravenousanesthetic,andthevariationofSAP,DAP,HR,RR,SpO2werecompared.Afteroperation,t

5、hesideeffectsuchasheadache,postoperativenauseaandvomitingwereobserved.Results:TheonsettimeofsensoryblockwasshorterintheCSEAgroupcomparedtothatintheEAgroup,andthequalityofanalgesiaandmusclerelaxationwasbetterinCSEAgroup.Thedoseoflocalanestheticandsupplementalintravenousanestheti

6、cusedinCSEAgroupwaslessthanthatusedinEAgroup（P＜0.0１）.Therewasnosignificantdifferenceinthehemodynamicchangesandpostoperativesideeffectbetweenthetwogroups.Conclusions:CSEAcanbesafelyandeffectivelyappliedtoagedbenignprostatichyperplasiapatientsintransurethralelectrovaporizationa

7、blationoftheprostate.Thekeyisindividualizedperioperativetreatmentandanesthetizingoperation.4　　【Keywords】Prostatichyperplasia;Prostatectomy,transurethral;Anesthesia;Aged　前列腺增生癥（benignprostatichyperplasia,BPH）是老年男性的常見(jiàn)病，隨著年齡增長(zhǎng)，其發(fā)病率逐漸上升，至85歲時(shí)，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(duì)高齡（>75

8、歲）合并嚴(yán)重心、腦、肺、肝、腎、糖尿病等的前列腺增生癥高?；颊叩氖中g(shù)麻醉，一直是臨床難點(diǎn)之一。2002年9月