Sun Xiaokun, Bai Nuo, Zhang Kaiping, Chen Meigui, Yu Yang, Ji Ying
Anesthesia Operating Room, Qingdao Hiser Hospital Affiliated of Qingdao University (Qingdao Traditional Chinese Medicine Hospital), 266000 Qingdao, Shandong, China.
Department of Gynecologic Oncology, Qingdao Central Hospital, University of Health and Rehabilitation Sciences (Qingdao Central Hospital), 266000 Qingdao, Shandong, China.
Arch Esp Urol. 2025 Jun;78(5):621-627. doi: 10.56434/j.arch.esp.urol.20257805.83.
Prostate cancer surgery is gradually increasing amongst the elderly. This study aims to compare the effect of intraspinal anaesthesia with that of general anaesthesia on elderly patients undergoing laparoscopic radical prostatectomy (LRP).
A total of 131 elderly patients receiving laparoscopic radical prostatectomy in our hospital from June 2020 to May 2023 were selected for retrospective analysis. A total of 59 patients receiving intraspinal anaesthesia were included in the observation group. After three patients were excluded, 56 patients were included. A total of 72 patients who received general anaesthesia were classified as the reference group. After two patients were excluded, 70 patients were finally included in the reference group. Perioperative indicators, stress response, P300 (P3) latency and amplitude parameters and adverse reaction incidence were compared between the two groups.
Operation, anaesthesia onset and anaesthesia recovery times in the observation group were significantly shorter than those in the reference group ( < 0.05). However, no difference was found in anaesthesia observation times between the two groups ( > 0.05). No distinct difference in levels of serum epinephrine (E), norepinephrine (NE) and cortisol (Cor) immediately before skin incision was found between the two groups ( > 0.05). The observation group had significantly lower levels of serum E, NE and Cor than the reference group at 1 h after the beginning of surgery, immediately after surgery and 2 h after surgery ( < 0.05). P3 latency and amplitude parameters did not significantly differ between the two groups before and 12 h after surgery ( > 0.05). The observation group had a significantly lower P3 latency at 1 and 6 h after surgery and significantly higher P3 amplitude parameters than the reference group ( < 0.001). The incidence of adverse reactions did not differ between the observation (8.93%) and reference (18.57%) groups ( > 0.05).
In elderly patients, intraspinal anaesthesia can shorten anaesthesia recovery time after LRP, reduce perioperative systemic stress response, and reduce the effect on the brain, which is helpful for patients' recovery after surgery.
前列腺癌手术在老年人中逐渐增多。本研究旨在比较蛛网膜下腔麻醉与全身麻醉对老年腹腔镜根治性前列腺切除术（LRP）患者的影响。
选取2020年6月至2023年5月在我院接受腹腔镜根治性前列腺切除术的131例老年患者进行回顾性分析。观察组纳入59例接受蛛网膜下腔麻醉的患者。排除3例患者后，纳入56例。72例接受全身麻醉的患者被分类为参照组。排除2例患者后，最终参照组纳入70例。比较两组患者的围手术期指标、应激反应、P300（P3）潜伏期和波幅参数以及不良反应发生率。
观察组的手术、麻醉起效和麻醉恢复时间显著短于参照组（<0.05）。然而，两组间的麻醉观察时间无差异（>0.05）。两组在皮肤切开前血清肾上腺素（E）、去甲肾上腺素（NE）和皮质醇（Cor）水平无明显差异（>0.05）。观察组在手术开始后1小时、手术结束后即刻及手术后2小时的血清E、NE和Cor水平显著低于参照组（<0.05）。两组在手术前和手术后12小时的P3潜伏期和波幅参数无显著差异（>0.05）。观察组在手术后1小时和6小时的P3潜伏期显著低于参照组，且P3波幅参数显著高于参照组（<0.001）。观察组（8.93%）和参照组（18.57%）的不良反应发生率无差异（>0.05）。
对于老年患者，蛛网膜下腔麻醉可缩短LRP术后的麻醉恢复时间，降低围手术期全身应激反应，并减轻对大脑的影响，有助于患者术后恢复。
