CSEA及全麻对老年前列腺切除术患者血流动力学参数及疼痛、认知的影响

doi:10.3969/j.issn.1671-7171.2023.02.025

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (1146 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要【目的】探讨腰麻-硬膜外联合麻醉(CSEA)及全麻对老年前列腺切除术患者血流动力学参数及疼痛、认知的影响。【方法】本院收治的128例行前列腺切除术老年患者,根据不同麻醉方式将患者的分为观察组(52例)和对照组(76例)。两组患者均行经尿道等离子前列腺电刀术治疗,观察组采用CSEA麻醉方式,对照组采用全麻麻醉方式。比较两组患者麻醉效果及麻醉诱导前(T₀)、气管导管插入即刻(T₁)、手术开始10 min(T₂)、拔管后10 min(T₃)血流动力学参数[平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO₂)]水平,采用蒙特利尔认知评估量表(MOCA)评估两组患者术前及术后1 d、3 d、7 d认知功能变化情况,于术后1 d采用疼痛视觉模拟评分法(VAS)评估两组患者疼痛感,比较两组患者不良反应发生情况。【结果】两组患者麻醉效果比较,差异无统计学意义(P>0.05);观察组与对照组T₀时MAP、HR、SpO₂水平比较,差异无统计学意义(P>0.05),观察组T₁、T₂、T₃时MAP、HR、SpO₂水平均高于对照组(P<0.05);观察组及对照组T₁时MAP、HR水平均高于T₀、T₂、T₃时,SpO₂水平低于T₀、T₂、T₃时(P<0.05);观察组麻醉时间长于对照组,重度疼痛率低于对照组,轻度疼痛率及无疼痛率高于对照组(P<0.05);观察组术后1 d、3 d MOCA评分均高于对照组(P<0.05);观察组患者不良反应发生率显著低于对照组(P<0.05)。【结论】与全麻比较,CSEA麻醉用于老年前列腺切除术患者镇痛效果显著,血流动力学稳定,对患者术后认知功能的影响较小,且不良反应较少。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	郝珍
	段浩

关键词 ：前列腺切除术, 麻醉, 全身/方法, 麻醉, 脊椎/方法, 麻醉,硬膜外/方法, 血流动力学

Abstract：【Objective】To investigate the effect of combined spinal-epidural anesthesia (CSEA) and general anesthesia on hemodynamic parameters,pain and cognition in elderly patients undergoing prostatectomy. 【Methods】A total of 128 elderly patients who underwent prostatectomy in our hospital were divided into the observation group of 52 cases and the control group of 76 cases according to different anesthesia methods. Both groups were treated with transurethral plasma electrosurgical surgery of the prostate,while the observation group was treated with CSEA anesthesia and the control group was treated with general anesthesia. The anesthesia effects of the two groups of patients were compared before anesthesia induction (T₀),immediately after tracheal intubation (T₁),10 minutes after surgery (T₂),and 10 minutes after extubation (T₃). So did hemodynamics [mean arterial pressure (MAP),heart rate (HR),blood oxygen saturation (SpO₂) level] at those time points. The Montreal Cognitive Assessment Scale (MOCA) was used to compare the two groups of patients before and 1,3 and 7 days after surgery. On the 1st day after the operation,the pain visual analog scale (VAS) was used to compare the pain sensation of the two groups of patients. The incidence of adverse reactions between the two groups of patients was compared as well. 【Results】There was no significant difference in anesthesia effect between the two groups (P>0.05). There was no significant difference in the levels of MAP,HR and SpO₂ between the observation group and the control group at T₀; And the levels of MAP,HR and SpO₂ in the observation group at T₁,T₂ and T₃ were higher than those in the control group. Levels of MAP and HR at T₁ in both observation group and control group were higher than those at T₀,T₂,and T₃,while the level of SpO₂ was lower than those at T₀,T₂,and T₃ (P<0.05). The anesthesia time of the observation group was longer than that of the control group. The rate of severe pain in the observation group were lower than that in the control group; And the rates of mild pain and no pain were higher than those in the control group. The MOCA scores of the observation group at 1 and 3 days after operation were higher than those of the control group. The incidence of adverse reactions in the observation group was significantly lower than that in the control group (P<0.05). 【Conclusion】Compared to general anesthesia,CSEA anesthesia has a significant analgesic effect in elderly patients undergoing prostatectomy,which provides stable hemodynamics,less impact of postoperative cognitive function,and reduced adverse reactions.

Key words： Prostatectomy Anesthesia, General/MT Anesthesia, Spinal/MT Anesthesia, Epidural/MT Hemodynamics

收稿日期: 2022-08-26

中图分类号:

R697.3

通讯作者: *E-mail:358243108@qq.com

引用本文:

郝珍, 段浩. CSEA及全麻对老年前列腺切除术患者血流动力学参数及疼痛、认知的影响[J]. 医学临床研究, 2023, 40(2): 248-251.
HAO Zhen, DUAN Hao. Effects of CSEA and General Anesthesia on Hemodynamic Parameters,Pain and Cognition in Elderly Patients undergoing Prostatectomy. JOURNAL OF CLINICAL RESEARCH, 2023, 40(2): 248-251.

链接本文:

http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2023.02.025 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2023/V40/I2/248

[1] OFOHA C G,RAPHAEL J E,DAKUM N K,et al. Surgical management of benign prostate hyperplasia in Nigeria:open prostatectomy versus transurethral resection of the prostate[J].Pan Afr Med J,2021,39(11):165.
[2] HOGAN D,KANAGARAJAH A,YAO H H,et al. Local versus general anesthesia transperineal prostate biopsy:Tolerability,cancer detection,and complications[J].BJUI Compass,2021,2(6):428-435.
[3] ZHOU Y,CHEN W,ZHOU S,et al. Comparison of different approaches to combined spinal epidural anesthesia (CSEA) under the guidance of ultrasound in cesarean delivery of obese patients:a randomized controlled trial[J].Eur J Med Res,2021,26(1):106.
[4] CHIAROTTO A,MAXWELL L J,OSTELO R W,et al. Measurement properties of visual analogue scale,numeric rating scale,and pain severity subscale of the brief pain inventory in patients with low back pain:a systematic review[J].J Pain,2019,20(3):245-263.
[5] FREITAS S,BATISTA S,AFONSO A C,et al. The Montreal Cognitive Assessment (MoCA) as a screening test for cognitive dysfunction in multiple sclerosis[J].Appl Neuropsychol Adult,2018,25(1):57-70.
[6] 邓超,刘少星,孙雪梅. 右美托咪定联合长托宁用于经尿道前列腺切除术的镇痛效果[J].现代泌尿外科杂志,2022,27(5):400-403.
[7] 郭晶晶,何志伟,董雪,等. 老年前列腺增生手术患者硬膜外联合全身麻醉的效果及对术后认知功能、炎症反应的影响[J].临床误诊误治,2021,34(3):85-90.
[8] 张仲金,薛静,王孝军. 前列腺电切术全麻与经蛛网膜下腔-硬膜外联合麻醉用于老年患者的临床效果[J].中国老年学杂志,2021,41(23):5223-5225.
[9] 潘丽峰,张殿红,董伟妍.妊娠合并肺动脉高压产妇剖宫产术应用腰麻-硬膜外联合麻醉对血流动力学和母婴结局的影响[J].中国计划生育学杂志,2022,30(3):587-591.
[10] 李亚东,张侃. 全麻和腰硬联合麻醉对老年下肢骨折手术患者循环功能、认知功能及疼痛的影响[J].解放军医药杂志,2020,32(1):102-105.
[11] 谷亚利,梁国庆.全身麻醉和腰硬联合麻醉对老年骨科患者术后短期认知功能的影响[J].贵州医药,2020,44(3):454-456.
[12] 李欣洁,程小兵,张宁. 硬膜外麻醉复合全身麻醉与全身麻醉对老年腹部手术患者围术期血流动力学变化与术后认知功能的影响[J].贵州医药,2021,45(10):1561-1562.