摘要
目的评价全麻复合硬膜外阻滞在上腹部手术中应用的可行性。方法 40例择期上腹部手术患者,ASAⅠ～Ⅱ,随机分为观察组(全麻复合硬膜外组)和对照组(全麻组)。两组全麻诱导和维持的方法相同,全麻诱导用芬太尼4μg/kg,丙泊酚1～2mg/kg,维库溴铵0.1mg/kg。观察组于诱导前取T8～9椎间隙行硬膜外穿刺置管,首次注入1.0%利多卡因加0.375%罗哌卡因的混合液3～5ml。测定平面后给追加量,麻醉平面控制在T4以下,全麻维持选用丙泊酚3～5mg/(kg.h)静脉持续泵入,间断静脉注射芬太尼,维库溴铵,需要时吸入0.5%～1.5%的异氟醚。记录在围麻期两组患者的SBP、DBP、MAP、HR、全麻用药量、苏醒时间及术后躁动等情况。结果观察组在切皮后和拔管后SBP、DBP、MAP及心率上升幅度均明显低于对照组(P<0.01)。观察组全麻用药量和术后躁动发生率明显低于对照组(P<0.01),苏醒时间较对照组短(P<0.01)。结论全麻复合硬膜外阻滞用于上腹部手术,血流动力学稳定,应激反应小,全麻用药量和术后躁动减少,苏醒迅速,是一种安全可行的麻醉方法 。
Objective To evaluate the feasibility and efficacy of general anesthesia combined with epidural anesthesia in upper abdominal surgery.Methods Forty patients with ASA grade Ⅰ to Ⅱ scheduled for elective upper abdominal surgery,were randomly divided into two groups：GE group（general anesthesia combined with epidural anesthesia）and G group（general anesthesia）.The methods of inducement and maintain of general anesthesia were same in both group.In both groups the general anesthesia was induced with intravenous fentanyl 4 μg/kg,propofol 1-2 mg/kg and vecuronium 0.1 mg/kg,and was maintained with intravenous infusion of propofol 3-5 mg.kg.h and intermittent bolus of vecuronium,fentanyl and/or inhalation of 0.5%-1.5% isoflurane.The patients in GE group were punctured into epidural space though T8-9 intervertebral space,and the duct was inserted towards head side.Fist dose 1% lidocaine and 0.375% ropivacaine was infused into the epidural space after test dose anesthesia plan.The anesthesia plan was under T4 level.Systolic blood pressure（SBP）,Diastolic blood pressure（DBP）,Mean artery pressure（MAP）,Heart rate（HR）,general anesthesia drug dosage,time of postoperative revival and postoperative revival were recorded.Results In GE group,the increase of SBP,DBP,MAP and HR at the time of skin incision and after tracheal extubation was significantly lower than those in G group（P〈0.01）,while the postoperative restlessness and general anesthesia dosage were lower than those in G group（P〈0.01）,the postoperative recovery time of GE group was also shorter（P〈0.01）.Conclusion General anesthesia combined with epidural anesthesia can stabilize the hemodynamics,endocrine disturbance as well as postoperative recovery time,reduce the stress to the surgery,and is more effectively and safely employed in upper abdominal surgery.
出处
《中华全科医学》
2010年第9期1102-1103,共2页
Chinese Journal of General Practice
关键词
麻醉
硬膜外
麻醉
全身
腹部外科手术
Epidural anesthesia
General anesthesia
Abdominal surgery
