Objective To evaluale the clinical efficacy and safely of combined spinal and epidural aneslhesia ( CSEA) in elder palienls who undertahen lower abdominal surgery. Methods 80 elderly patienls (ASA class Ⅱ - Ⅲ ) scheduled for selective abdominal surgery were allocated randomly to eilher conlinuous epidural aneslhesia(CEA) group or combined spinal and epidural aneslhesia (CSEA) group( n =40, each group) . MAP, HR and SpO2 were recorded in the first hour after aneslhesia. The onset lime, sensory block level, perfect lime, quality of aneslhesia and the side effects such as headache were observed after operation. Results The two groups of bleeding had no significant difference. But the downtrend of blood pressure in CSEA group and bradycardia were significantly less than those in CEA group( P <0. 05) . The two groups reported no headache. The onset time and perfect time of anesthesia in CSEA group were significantly shorter than those in CEA group( P <0. 01) . The effect of anesthesia in CSEA group( 100% ) was better than CEA group( 80% ) . The anesthetic highest level under T8 did not differ between the two groups. Con-rnclusion CSEA is a safe and effective melhod for the elder palienls underlahen lower abdominal surgery.%目的 研究腰硬联合麻醉用于老年患者下腹部手术的可行性和安全性.方法择期拟行下腹手术老年患者80 例,ASAⅡ～Ⅲ级,随机分成连续硬膜外阻滞(CEA)组和腰硬联合麻醉(CSEA)组,每组40例.记录麻醉后1 h内平均动脉压(MAP)、心率(HR)及血氧饱和度(SpO2)的变化,并观察起效时间、麻醉平面、麻醉完善时间、麻醉效果,术后随访有无头痛等副作用.结果 两组出血量差异无统计学意义,CSEA组血压下降、心动过缓明显少于CEA组(P<0.05),术后均无头痛.CSEA组起效时间、阻滞完善时间明显短于CEA组(P<0.01),CSEA组麻醉效果优良者100%,CEA组麻醉效果优良者80%,CSEA组效果优良者明显高于CEA组(P<0.05),两组麻醉最高平面均在T8以下,差异无统计学意义.结论 腰硬联合麻醉可安全、有效用于老年患者下腹部手术.
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