不同麻醉方法用于胸科手术患者的效果

目的探讨胸科手术不同麻醉方法的效果。方法择期拟行胸科手术患者90例,性别不限,年龄18～65岁,ASA分级Ⅱ或Ⅲ级。采用随机数字表法,将患者分为2组(n=45):静吸复合全麻组(Ⅰ组)和全麻联合硬膜外麻醉组(Ⅱ组)。Ⅰ组麻醉诱导后,吸入七氟醚,持续输注丙泊酚维持麻醉;Ⅱ组先采取硬膜外麻醉,麻醉平面稳定后全麻诱导,吸入七氟醚维持麻醉。于术前30 min时、术中10 min时、术后10 min时记录患者的SBP、MAP、DBP、HR、SpO2。术毕记录患者气管导管拔管时间、自主呼吸恢复时间及完全清醒时间,并记录气管导管拔管即刻(T1)、拔管后5 min(T2)、10 min(T3)及20 min(T4)的RSS镇静评分。结果与Ⅰ组比较,Ⅱ组术中及术后10 min时SBP、MAP、DBP和HR降低,自主呼吸恢复时间、拔管时间及完全清醒时间显著缩短,T1-4时RSS镇静评分明显升高(P0.05)。结论全麻联合硬膜外麻醉用于胸科手术的效果优于静吸复合麻醉。

Efficacy of different methods of anesthesia for thoracic surgery

Objective To investigate the efficacy of diffemnt methods of anesthesia for thoracic surgery. Methods Ninty ASA physical status Ⅱ or Ⅲ patients of both sexes, aged 18 - 65yr, scheduled for thoracic surgery, were randomly divided into 2 groups （ n = 45each） ： combined intravenous - inhalational anesthesiagroup （ group Ⅰ ） and combined epidural anesthesia ＋ general anesthesia group （ group Ⅱ ）. In group Ⅰ , anesthesia was maintained with inhalation of sevoflurane and irffusion of propofol after induction of anesthesia. In group Ⅱ, epidural anesthesia was performed,after the upper level of sensory block was stable, general anesthesia was induced and maintained with inhalation of sevoflurane. SBP,MAP,DBP,HR and SpO2 were recorded at the time of preoperative 30min, intraoperative 10min and postoperative 10min. The time for recovery of spontaneous breathing, extubation time and time of regaining consciousness were recorded. Ramsay Scores were obtained immedi- ately before extubation（ T1 ） ,5min after extubation（ T2 ）, 10min after extubation（ T3 ） and 20min after extubation（ T4 ）. Results Compared with group Ⅰ ,in group Ⅱ the SBP,MAP,DBP and HR were significantly decreased at the time of intraoperative 10min and postoperative 10min. The time for recovery of spontaneous breathing, extubation time and time of regaining consciousness were significantly shortened, the RSS sedation scores were increased at the time of T1-4 （P 〈 0. 05 ）. Conclusion combined epidural anesthesia ＋ general anesthesia has better efficiency than combined intravenous - inhalational anesthesia when used for thoracic surgery.