Objective To observe the feasibility and safety of 0.5% equally weighted bupivacaine spinal and epidural anesthesia in lower abdominal surgery for elderly over the age of 70. Methods 120 patients over the age of 70 with class ASA Ⅰ - Ⅲ who would receive elective lower abdominal surgery were randomly divided into the combined spinal and epidural anesthesia (CSEA) group and the continuous epidural anesthesia (CEA) group. The post-anesthetic sensory level onset time, block perfection time, maximum sensory block level, dosage of local anesthetics, anesthetic effects and adverse reactions were observed. Results The anesthetic onset time and block perfection time of CSEA group were significantly faster than the CEA group (P < 0.01), but significantly less than the CEA group in the dosage of local anesthetics (P < 0.01). The anesthetic good and excellent rate of the CSEA group was 100%, which was higher than the 83% of the CEA group, with statistically significant difference (P < 0.01). The differences of the maximum sensory block level and the adverse reactions between the two groups were not statistically significant (P > 0.05). Conclusion With proper medication and operation, 5% equally weighted bupivacaine CSEA can be safely and effectively used in the lower abdominal surgery for elderly over the age of 70.%目的 观察0.5%等比重布比卡因腰硬联合麻醉在70岁以上老年人下腹部手术中应用的可行性和安全性.方法 120例70岁以上择期行下腹部手术患者,ASA Ⅰ～Ⅲ级,随机分为腰硬联合麻醉(CSEA)组和连续硬膜外麻醉(CEA)组,观察麻醉后感觉平面起效时间、阻滞完善时间、最高感觉阻滞平面、局麻药用量、麻醉效果及其不良反应.结果 CSEA组麻醉起效时间、阻滞完善时间显著快于CEA组(P ＜ 0.01),局麻药用量显著少于CEA组(P ＜ 0.01),CSEA组的麻醉优良率(100%)高于CEA组(83%),差异有高度统计学意义(P ＜ 0.01),最高感觉阻滞平面、不良反应两组差异无统计学意义(P ＞ 0.05).结论 只要用药和操作得当,0.5%等比重布比卡因CSEA可安全有效地应用于70岁以上老年人下腹部手术.
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