【摘 要】
：
目的：探讨针刺复合小剂量硬膜外麻醉对老年骨科手术机体应激反应的影响.
方法：选择120例拟行下肢骨科手术的老年患者,年龄65-85岁,ASAⅡ-Ⅲ级,随机分为针刺复合小剂量硬膜
【机 构】
：
甘肃中医学院附属医院甘肃兰州730020
【出 处】
：
第三届全国中西医结合治疗肝病临床经验学术研讨会
论文部分内容阅读
目的：探讨针刺复合小剂量硬膜外麻醉对老年骨科手术机体应激反应的影响.
方法：选择120例拟行下肢骨科手术的老年患者,年龄65-85岁,ASAⅡ-Ⅲ级,随机分为针刺复合小剂量硬膜外麻醉组(A组)和单纯小剂量硬膜外麻醉组(B组)每组60例.两组均选择L-2ˉ3或L3ˉ4硬膜外穿刺置管,穿刺成功后给予试验剂量1.5％利多卡因3ml,待麻醉平面出现后,A组选穴定位,针刺相应穴位,得气后接电针,调节强度与频率至患者可耐受水平,针刺10分钟后测麻醉平面,如未达到所需平面(T10-L4),硬膜外小剂量每次追加1.5％利多卡因(每次3ml),直至麻醉效果完善(Ⅰ-Ⅱ级)后开始手术,B组除针刺外,均与A组相同.记录两组硬膜外局麻药用药量,麻醉效果.记录两组麻醉前(T0)、麻醉后20min(T1)、切皮前(T2)、手术开始后60min(T3)及手术结束时(T4)HR、SBP、DBP、MBP,记录术前24h、T3、T4及术后24h血糖及皮质醇水平.
结果：硬膜外用药量A组较B组减少35.5％(P＜0.01);麻醉效果Ⅰ级率A组96％,B组83％,两组比较(P＜0.05);A组T1、T2及T3HR、SBP、MBP变化小于B组(P＜0.05);A组血糖水平在T3、T4均低于B组(P＜0.05);A组血浆皮质醇水平在T3、T4及术后24h均低于B组(P＜0.01或P＜0.05).
结论：针刺复合小剂量硬膜外麻醉效果优于单纯小剂量硬膜外麻醉,术中循环稳定,应激反应轻,可作为老年下肢骨科手术麻醉方法之一.
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