摘要
目的 观察硬膜外阻滞与全身麻醉时，腹部手术患者术中的体温变化，以及这种变化对氧摄取量的影响。方法 82例行择期腹部手术的患者，ASAⅠ～Ⅱ级，随机均分为两组，硬膜外麻醉组（Ⅰ组）、全身麻醉组（Ⅱ组）。Ⅰ组的硬膜外阻滞平面控制在T4～S2水平。Ⅱ组应用芬太尼0．2mg、咪唑安定2～3mg、丙泊酚1～1．5mg／kg、维库溴铵0．1mg／kg行诱导插管，吸入异氟醚并静脉泵入丙泊酚加芬太尼的混合液维持麻醉，间歇静脉注射维库溴铵维持肌松。术中持续监测记录血压及心率、食管下段温度（Te）、大腿内侧皮肤温度（Ts）、氧吸入和呼出浓度、呼气末CO2分压。结果 两组患者术中血压及心率均较平稳。Ⅰ组中食管下段温度于术后80min时降至最低点（P〈0．05），大腿内侧皮肤温度呈持续升高的趋势。Ⅱ组中食管下段温度于术后40min时降至最低点（P〈0．05），大腿内侧皮肤温度与食管下段温度变化趋势相似。术中Ⅰ组和Ⅱ组随着中心体温的下降，氧摄取量均较术前减少，但Ⅰ组中合并有寒战的患者氧摄取量明显术前增加（P〈0．05）。结论 全麻和硬膜外麻醉均可致中心温度下降，氧摄取量下降，但全麻较硬膜外阻滞的体温下降更快，幅度更大，但硬膜外阻滞低中心体温引发寒战时，可显著增加术中氧摄取量。
Objective To observe the effects of general anesthesia and epidural anesthesia on temperature and oxygen upraise of the patients undergoing laparotomy. Methods Eighty-two patients undergoing laparotomy were randomly divided into group Ⅰ （epidural anesthesia） and group Ⅱ （general anesthesia）. The blocking area was controled between T4 and S2 in group Ⅰ, isoflurance inhalational anesthesia was combined with lepropofol-fentanyl intravenous anesthesia in group Ⅱ. Blood pressure,heart rate,inferior-esophagus temperature（Te） ,medial-thigh skin temperature（Ts） ,inhaling and exhaling concentration of oxygen and carbon dioxide at the end of exhalation during operation were measured. Results In group Ⅰ ,Te decreased to the nadir at 80min after operation（P 〈0.05） ,Ts rised throughout the operation. In group Ⅱ ,Te decreased to the nadir at 40min after operation（P〈0.05） ,changes of Ts were similar to those of Te. The oxygen uptake was declined as Te decreasing in both groups（P〈0.05）. The oxygen uptake was obviously increased for patients with shivering in group Ⅰ. Conclusion Both general anesthesia and epidural anesthesia make Te and oxygen uptake decline during operation. But shiver triggered by low-core temperature could make oxygen uptake obviously increased during epidural anesthesia.
出处
《重庆医学》
CAS
CSCD
2006年第8期681-682,共2页
Chongqing medicine
关键词
硬膜外麻醉
全麻
氧摄取量
体温
寒战
general anesthesia
epidural anesthesia
oxygen uptake
temperature
shiver
