胸段硬膜外复合静脉全麻与全凭静脉麻醉在开胸手术中的比较

目的 比较胸段硬膜外复合静脉全麻与全凭静脉麻醉对开胸手术患者血流动力学、麻醉药维持剂量、术后苏醒、躁动及疼痛的影响.方法 64例择期行剖胸手术患者,ASA Ⅱ级～Ⅲ级,采用完全随机设计的方法分为2组.A组:胸段硬膜外复合静脉全麻组,患者预先用10 ml 0.25%布比卡因和0.1 mg芬太尼硬膜外给药.术中硬膜外0.25%布比卡因和芬太尼10μg/ml,5 ml/h复合丙泊酚维持.B组:全凭静脉麻醉组,丙泊酚-端芬太尼全凭静脉麻醉.观察并记录不同时间点2组心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、所需麻醉维持药量、术毕清醒及出现疼痛时间.结果 2组患者各观察点血流动力学变化比较,差异无统计学意义;胸段硬膜外复合静脉全麻组麻醉维持不需要静脉镇痛药瑞芬太尼和肌松药阿曲库铵,只需复合充分的丙泊酚镇静,就能满足手术需求;术后苏醒早;拔管时间(11±4)min,相对于全凭静脉麻醉组(23±16)min明显缩短(P<0.05):躁动例数显著减少;术后出现疼痛时间(7.4±2.6)min相对于全凭静脉麻醉组(0.5士0.3)min明显延长(P<0.01).结论 胸段硬膜外复合静脉全麻用于开胸手术快通道麻醉是一种安全、经济、有效并有利于患者术后恢复的麻醉方法.

Comparison of thoracic epidural anesthesia combined intravenous and total intravenous anesthesia in thoracic surgery

Objective To compare thoracic epidural anesthesia (TEA)combined with general anesthesia (GA)and total-IV anesthesia (TIVA)with respect to haemodynamic differences, maintenance dosage of narcotic, recovery profile and postoperative pain.Methods Sixty-four patients, ASA physical status Ⅰ-Ⅲ undergoing thoracotomy were randomly allocated to two groups: thoracic epidural anesthesia(TEA)combined with general anesthesia (GA) group(group A) and total-IV anesthesia(TIVA) group(group B).Patients in the A group received 10 ml of 0.25% bupivacaine and fentanyl 0.1mg via the epidural route prior to skin incision, followed by an infusion of bupivacaine 0.25% and fentanyl 10 μg/ml at 5 ml/h. Group B received propofol target controlled infusion system and remifentanil. Results No statistically significant differences between the two groups with regards to the haemodynamic changes.Maintenance of anesthesia in TEA combined with GA group neither muscle relaxants nor opioid anesthetics were required. Extubate times were considerably shorter after TEA combined with GA (11±4) min in comparison with TIVA (23±16) min target controlled infusion system group (P<0.05). The emerge of postoperative pain time were considerably longer after TEA combined with GA (7.4±2.6) min in comparison with TIVA (0.5±0.3) min target controlled infusion system group (P<0.01). Conclusion Thoracic epidural anesthesia combined with general anesthesia for thoracotomy is rapid, safe, economic and effective method, moreover, in favor of the patients' postoperative recovery.