摘要
目的比较喉罩与气管插管用于全身麻醉(全麻)或全麻复合硬膜外阻滞麻醉患者的血流动力学、皮质醇水平的影响。方法 60例拟行乳腺癌根治手术患者随机均分为全麻气管插管(T)组、全麻气管插管+硬膜外阻滞(ET)组和全麻喉罩+硬膜外阻滞(EL)组,每组20例。复合组行硬膜外穿刺(T3～4),硬膜外术中以每小时0.33%盐酸罗哌卡因5 mL维持。全麻诱导用异丙酚、维库溴胺、芬太尼及咪唑安定,记录入室静卧10 min后(T1),麻醉插管前1 min(T2)、插管后1 min(T3)、手术结束时(T4)、拔管后1 min(T5)各时相点MAP、SpO2及HR,并于各时相点抽血查皮质醇。同时观察患者麻醉药物的用量,以及术后躁动、咽痛、恶心呕吐等副作用的发生率。结果气管插管复合硬膜外阻滞组和喉罩复合硬膜外阻滞组在用药量、清醒时间、皮质醇改变与单纯全麻组比较,差异有统计学意义(P<0.05),喉罩复合硬膜外阻滞组发生术后躁动、咽痛的例数明显低于其他两组(P<0.05),呕吐的发生率3组间差异无统计学意义(P>0.05)。结论喉罩复合硬膜外阻滞的麻醉方法能有效减轻术中患者的应激反应,并且可减少全麻药用量,术后躁动,咽痛的发生率,是一种用于乳腺癌根治的较好的麻醉方法。
【Objective】 To compare the effect of different anesthesia on hemodynamics and the level of cortisol in patients undergoing radical mastectomy.【Methods】 Sixty patients undergoing radical mastectomy were randomly divided into three groups general anesthesia（group T,n =20）,epidural anesthesia combined with general anesthesia（group T n =20） and epidural anesthesia combined with LMA anesthesia（group T n =20）.An epidural cather was inserted at the T3～4 interspace before induction of general anesthesia.Epidural anesthesia was maintained by 0.33% ropivcacine 5 mL every hour： Midazolam 0.06 mg/kg Fentanil 4 μg/kg,and Vecuronium 0.10 mg/kg Propofol 1.5 mg/kg were used for the induction of general anesthesia in group（T and EL）.MAP,SpO2,HR,were observed at the time before anesthesia（T1）,before intubation（T2）,1 min after intubation（T3）,the end of operation（T4）,1 min after extubation（T5）.Arterial blood samples were collected at T1,T2,T3,T4 and T5 for determination of cortisol.We also record the amount of Propofol,Vecuronium and Fentanil and observed some adverse events of anesthesia,such as pharyngolysis,move restless,nausea and vomitting.【Results】 The change of the level of cortisol,the time of recovery and the amount of Propofol,Fentanil and Vecuronium of group ET and EL are significant lower than that in group T（P 0.05）.The adverse events of anesthesia,pharyngolysis and move restless,of group EL are significant lower than that in group T and group ET（P 0.05）.There were no significant difference between the three groups in vomitting（P 0.05）.【Conclusions】 The anesthesia method of epidural anesthesia combined with LMA can allay the stress responses and reduce the amount of narcotics and the rate of pharyngolysis and move restless.So it is a good anesthesia method of radical mastectomy.
出处
《中国现代医学杂志》
CAS
CSCD
北大核心
2012年第17期71-74,共4页
China Journal of Modern Medicine
关键词
硬膜外阻滞
全身麻醉
喉罩
皮质醇
应激
epidural anesthesia
general anesthesia
laryngeal mask airway
cortisol
stress response
