两种不同麻醉方法对胸科手术后持续硬膜外镇痛效果的影响

目的比较胸段硬膜外阻滞复合全身麻醉与静脉全身麻醉对胸科手术后持续硬膜外镇痛的效果。方法20例行食管癌根治术患者随机分为两组：胸段硬膜外阻滞复合全身麻醉组（GEA组）和静脉全身麻醉组（GA组），每组10例。术毕均采用0．125％罗哌卡因和0．5μg/ml舒芬太尼硬膜外持续镇痛，观察术后6h、12h、24h和48h的静息和咳嗽疼痛视觉模拟评分（VAS）、生命体征、辅助药用量、有或无恶心、呕吐、皮肤瘙痒等副作用。结果GEA组在静止和活动状态下术后6h、12h、24h的VAS评分小于GA组，差异有显著意义（P〈0．05）；GEA组在术后12h和24h时MAP低于GA组，差异有显著意义（P〈0．05），两组在各时点呼吸频率和脉搏氧饱和度的差异均无显著意义（P〉0．05）。结论胸段硬膜外阻滞复合全身麻醉比静脉全身麻醉开胸术后硬膜外镇痛效果更好。

Effects of different anesthetic methods on postoperative continuous epidural analgesia in patients undergoing thoracic surgical procedures

Objective To compare the effects of two different anesthetic methods on the postoperative continuous epidural analgesia in patients undergoing thoracic surgical procedures. Methods Twenty ASA Ⅰ -Ⅲ patients undergoing esophagectomy were randomly divided into two groups, group GEA （ either combined general-epidural anesthesia ） and group GA（general anesthesia）. In group GEA, epidural catheter was placed at T7 -T8, epidural block was performed before general anesthesia. Anesthesia was induced with 2 -4μg/kg fentanyl, 0. 15 mg/kg vceuronium and 1.5 - 2. 0 mg/kg propofol . Double lumen tube was inserted and the patients were mechanically ventilated with 100%. Anesthesia was maintained with propofol ,veeuronium and epidural infusion of 1% lidoeaine plus 0.125% bupivacaine （4 - 6 ml/h）. After operation PCEA with 0. 125 % ropivacaine combined with 0.5μg/ml sufentanil was started （ background infusion 2 ml/h , bolus 0. 5 ml,lock-out time 15 min）. In GA group the induction and maintenance of anesthesia were more of the same except epidural infusion. VAS scores were used to assess analgesia at rest and during move . MAP, RR,SpO2 and side effects （ nausea, vomiting, pruritus） were recorded. Results The VAS scores in group GEA were significantly lower than in group GA during the 48 hours after operation（ P 〈 0.05 ） , MAP in group GEA were significantly lower than in group GA （ P 〈 0. 05 ） . Conclusion Compared with general anesthesia , general-epidural anesthesia can provide effectively analgesia without more side effects after major thoracic surgery.