Heller A R, Litz R J, Djonlagic I, Manseck A, Koch T, Wirth M P, Albrecht D M
Klinik und Poliklinik für Anaesthesiologie und Intensivmedizin, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden.
Anaesthesist. 2000 Nov;49(11):949-59. doi: 10.1007/s001010070030.
Patients requiring radical prostatectomy (rPE), including retroperitoneal lymphadenectomy are often aged and have coexisting cardiopulmonary diseases, increasing the risk of perioperative complications. The aim of the present study was to evaluate our perioperative anaesthesiologic regimen over the last five years, in terms of safety and patients comfort. Records of 433 patients who underwent rPE between 1994 and 1999 in our hospital were retrospectively reviewed. Patients were divided in those who received: 1. general anaesthesia (GA) alone, 2. a combination of lumbar epidural anaesthesia (LEA) + GA or, 3. thoracic epidural anaesthesia (TEA) + GA. General anaesthesia was performed as balanced anaesthesia, and epidural administered local anaesthetics were bupivacaine 0.25% or ropivacaine 0.2%, 8-12 ml/h. In terms of intra- and postoperative numbers of tachycardiac and hypertensive episodes, a reduced stress response was observed under epidural anaesthesia (EA). Moreover, the weaning duration was shorter under EA and onset of gastrointestinal motility was found earlier ([h] GA: 50.6 +/- 11.1/LEA: 39.3 +/- 13.6/TEA: 33.8 +/- 13.0). Furthermore, a trend to rarer phases of postoperative vomiting and a significant decrease of in hospital stay of about one day ([d] GA: 12.4 +/- 5.8/LEA: 11.1 +/- 3.1/TEA: 11.5 +/- 3.8) was observed. The duration of personnel binding in the OR did not differ significantly between GA and TEA ([min] GA: 222.9 +/- 43.5/LEA: 238.2 +/- 41.8/TEA: 227.0 +/- 46.2), but ICU stay was shortened under TEA. Besides this, TEA reduced the number of pathologic postoperative thorax-x-rays. Senso-motor blockades, decreases of SaO2 and cardiac complications were experienced more frequent under LEA as compared with TEA. Combination of GA and EA, especially TEA, appears to improve perioperative care of patients undergoing rPE, in terms of patients safety and comfort.
需要进行根治性前列腺切除术（rPE）（包括腹膜后淋巴结清扫术）的患者通常年龄较大且并存心肺疾病，这增加了围手术期并发症的风险。本研究的目的是从安全性和患者舒适度方面评估我们过去五年的围手术期麻醉方案。对1994年至1999年期间在我院接受rPE的433例患者的记录进行了回顾性分析。患者被分为接受以下麻醉方式的三组：1. 单纯全身麻醉（GA）；2. 腰段硬膜外麻醉（LEA）+GA联合麻醉；3. 胸段硬膜外麻醉（TEA）+GA联合麻醉。全身麻醉采用平衡麻醉，硬膜外给予的局部麻醉药为0.25%布比卡因或0.2%罗哌卡因，8 - 12 ml/h。在术中和术后心动过速和高血压发作次数方面，硬膜外麻醉（EA）下观察到应激反应降低。此外，EA下脱机时间更短，胃肠道蠕动开始时间更早（[小时]GA：50.6±11.1/LEA：39.3±13.6/TEA：33.8±13.0）。此外，观察到术后呕吐阶段更少见的趋势，且住院时间显著缩短约一天（[天]GA：12.4±5.8/LEA：11.1±3.1/TEA：11.5±3.8）。GA和TEA在手术室的人员约束时间无显著差异（[分钟]GA：222.9±43.5/LEA：238.2±41.8/TEA：227.0±46.2），但TEA下重症监护病房（ICU）停留时间缩短。除此之外，TEA减少了术后胸部X线检查异常的数量。与TEA相比，LEA下感觉运动阻滞、SaO₂下降和心脏并发症的发生率更高。GA和EA联合麻醉，尤其是TEA，在患者安全性和舒适度方面似乎改善了接受rPE患者的围手术期护理。
