胸段硬膜外镇痛对肺叶切除患者应激反应、气管拔管时循环功能和术后肺功能恢复的影响

目的 观察胸段硬膜外镇痛(thoracic epdidural anaesthesia，TEA)对肺叶切除患者血糖、拔管期间呼吸、循环功能和术后48h肺功能恢复的影响。方法 18例患者随机分为TEA组(n＝9)和对照组(n＝9)，于麻醉前、术中30min、60min、术毕120min、和术后第l、2天测血糖；拔管前、拔管时、拔管后5min和10min测HR、BR、SPO2、Et—CO2、心律，术前和术后48h测定肺功能(MVV和FEVl)。结果 两组病人术中血糖自30min明显升高(P＜0．05)，术后第l、2天TEA组已恢复正常，而对照组仍高于正常水平(P＜0．05)。拔管期间的血压、心率在TEA组无明显改变，而对照组变化较为明显，与拔管前比较差异有显著性(P＜0．05)。术后48h肺功能与术前比较均有不同程度的降低，但TEA组变化较轻微，而对照组则较明显(P＜0．05)。结论 TEA有利于肺叶切除患者手术后早期拔除气管插管以及术后血糖和肺功能的恢复，可以缓解肺叶切除患者手术应激反应，减轻术后糖代谢紊乱。

The effect of thoracic epidural analgesia on blood glucose levels,circulation functon during tracheal extubation and postoperative pulmonary function in patients undergoing pulmonary lobectory

Objective To evaluate the effect of thoracic epidural analgesia(TEA) on blood glucose levels, circulatory during trachea1 extubation and postoperative pulmonary function in patients undergoing pul-moary lobectory. Methods 18 ASA 1111111111 or 222222222 patients were randomly divided into two groups: TEA group and control group. Blood glucose levels were observed: before anaesthesia, 30min and 60rnin after beginning of operation, 120min and the 1st and 2nd days after surgery. Pulmonary function were observed before anaesthesia, and 48 hour after surgery. BP, HR, EtCO2, SPO2 were reasured every 5min during operation. Results Blood glucose levels were increased significantly dueing operation in two groups; they recovered to normal in TEA group in the first and second days. While they were still high in control group(P < 0.05). Pulmonary function were decreased postoperatively, but it was much batter in TEA group than in control group(P < 0,05). BP and HR were stable in TEA group during extubation contrasted to control group (P < 0.05) . Conclusions TEA may beneficial to the staltization of blood glucose level and circulation during tracheal extubation and better recovery of pulmonary function in patients after pulmonary lobeatory.