摘要
目的 评价全麻复合硬膜外阻滞对老年上腹部手术病人循环及应激反应状态的影响。方法 30例ASAⅠ～Ⅱ级、择期上腹部手术老年病人 ,随机分为单纯全麻组 (对照组 )和全麻复合硬膜外阻滞组 (研究组 )。两组全麻诱导和维持方法相同 ,全麻诱导用咪唑安定 0 0 5mg/kg、芬太尼4 μg/kg、丙泊酚 1 5mg/kg、阿曲库铵 0 2mg/kg、琥珀胆碱 1 5mg/kg。研究组于诱导前取T9～ 10 椎间隙行硬膜外穿刺置管 ,注入 2 %利多卡因 3～ 4ml,测定麻醉平面后给追加量 ,麻醉平面控制在T4平面以下。间断静注咪唑安定、芬太尼和阿曲库铵并吸入 0 5 %～ 1%异氟醚维持麻醉。于麻醉前、切皮后 10分钟、切皮后 1小时、术毕时采外周静脉血测定血清皮质醇、血管紧张素 Ⅱ (A Ⅱ )、白细胞介素 6 (IL 6 )的浓度 ;记录循环指标、全麻药用量及术中知晓、术后躁动情况。结果 研究组血清皮质醇、A Ⅱ浓度在手术 1小时、术毕时明显低于对照组 (P <0 0 5 ) ;两组间血清IL 6水平无显著性差异。研究组术毕时HR明显低于对照组 (P <0 0 5 ) ,术中SBP、DBP明显低于对照组 (P <0 0 5和P<0 0 1)。 30例病人术毕血清IL 6浓度与手术时间呈正相关 (r =0 5 7,P <0 0 5 )。研究组全麻药用量和术后躁动例数低于对照组 ,而术中知晓例数高于对照组?
Objective To evaluate the efficacy of combined general anesthesia with epidural block (CGEA) for upper abdominal surgery in the elderly.Methods Thirty elderly patients,ASAⅠ Ⅱ,scheduled for elective upper abodominal surgery,were divided randomly into control group and study group.In both groups general anesthesia was induced with midazolam,fentanyl,propofol,atracurium and succinylcholine,and maintained with intermittent bolus of midazolam,fentanyl,atracurium and inhalation of 0 5% 1% insoflurane.In study group,T 9 10 epidural block was performed before induction.Hemodynamics was measured and intraoperative awareness,postoperative restlessness and general anesthetic dosage were recorded.Serum concentration of cortisol,angiotension (AⅡ) and interleukin 6 (IL 6) were determined before anesthesia (T 1),at 10min after incision (T 2) and 1h after incision (T 3) and at the end of surgery (T 4).Results In study group,serum cortisol and AⅡ concenration at T 3,T 4 were higher than the basline levels,decreased significantly compared with those in control group ( P< 0 05).Serum IL 6 concentrations increased significantly in both groups ( P< 0 05),and serum IL 6 concentration at T 4 was correlated positively to the operation duration ( r= 0 57, P< 0 05).In study group,HR at T4,SBP and DBP during operation were decreased significantly componed with those in the control group.Conclusions General anesthesia combined with epidural block can stabilize the hemodynamics and reduce the stress respones to surgery in elderly patients undergoing upper abdominal operation,which can be applied safely and effectively. [
出处
《临床麻醉学杂志》
CAS
CSCD
2002年第12期637-639,共3页
Journal of Clinical Anesthesiology
