两种麻醉方法在肝叶切除术中的效能比较

目的：探讨全凭静脉麻醉与静脉复合硬膜外麻醉2种方法在肝叶切除术的麻醉效能。方法：择期肝叶切除术患者58例，随机分为2组：全凭静脉麻醉组29例直接行全麻诱导；静脉复合硬膜外麻醉组29例先行硬膜外穿刺，给予2％利多卡因4ml，确定效果后，行麻醉诱导，2组诱导均选用咪达唑仑、芬太尼、维库溴胺，术中维持采用丙泊酚，间断给予维库溴胺。比较2组丙泊酚、维库溴胺、芬太尼、罗哌卡因的用药总量及手术时间，停止给予丙泊酚到患者清醒拔管的时间及有无术中知晓，术后清醒时切口是否疼痛。结果：2组患者均无术中知晓，清醒时切口均无疼痛。与全凭静脉麻醉组相比，静脉复合硬膜外麻醉组清醒拔管时间明显缩短（P〈0．05），芬太尼、维库溴胺、丙泊酚的用药总量及药品价格均明显降低（P〈0．05）。结论：静脉复合硬膜外麻醉用于肝叶切除术，可以明显减少静脉麻醉剂芬太尼、丙泊酚及肌松剂维库溴胺的用量，并且术中血压、心率稳定，易于管理，术后苏醒拔管迅速，节约费用。

The comparison of effects of two methods of anesthesia in major liver resection

Objective: To compare the effects of two anesthetic techniques in major hepatic resection by the amounts of intravenous anesthetic agents and vecutonium, heart rate(HR), mean arterial pressure(MAP) and the times of stopping propofol to extubation. Methods: Fifty-eight patients who were undergoing elective major liver resection were randomly divided into two groups: total intravenous anesthesia group and combined general-epidural anesthesia group. In combined general-epidural anesthesia group epidural puncture was performed at T8-9 or T9-10. After catheter was fixed, 2% lidocaine 4ml were infused into epidural, when the epidural anesthesia was working the general anesthesia was induced. In both groups, anesthesia was induced with midazolam, vecuronium, fentanyl and maintained with propofol. Vecuronium was given when necessary. In combined general-epidural anesthesia group, before skin incision 1% ropivacaine (50 mg) was given through epidural catheter and the same dosage was given in every 2 hours. The total volumes of ropivacaine were recorded. In the both groups, electrocardiogram, non-invasively arterial pressure, arterial oxygen saturation, airway pressure and urine production were monitored continuously. Fentanyl and vecuronium were stopped 30 minute before the end of operation. Propofol was stop when closing peritoneum. Total volumes of propofol, fentanyl, vecuronium and the operation's times, times of stop-ping-propofol to extubation and whether having awareness at interoperation, whether having pain were all recorded in both groups. Results: In both groups none of patient has awareness and pain. The amounts of fentanyl, vecuronium, propofol and the cost in total intravenous anesthesia group were significantly higher than combined general-epidural anesthesia group (P<0.05), the time of stopping-propofol to extubation is also longer than it (P<0. 05). In the combined general-epidural anesthesia group, the change of MAP during operation is insignificant compare to baseline, but it increase significantly in the total intravenous anesthesia. Conclusions: Combined general-epidural anesthesia in hepatectomy can decrease the amount of fentanyl, vecuronium and propofol and more stability of hemodynamic, earlier extubation, more safety and economy.