硬膜外麻醉与静脉复合全麻用于胆道手术的比较（附1515例分析）

目的 提高胆道手术的安全性，减少或避免胆心反射所致循环骤停的发生。方法 1515例胆道手术患者分为静脉吸入复合全麻组和硬膜外组。静脉吸入复合全麻组715例，均在芬太尼、异丙酚复合异氟醚气管内全麻下完成手术；硬膜外组800例，均于下胸段采用1％利多卡因、0．375％布比卡因间断硬膜外推液阻滞麻醉下手术。两组均行SPO2、ECG、BP、R监测。以术中胆心反射和心跳骤停发生率为观察指标，比较两种麻醉方法在胆道手术中的应用。结果 静脉复合全麻组胆心反射发生率10％，无心跳骤停发生；硬膜外组胆心反射发生率42．5％，心跳骤停0．62％。结论 胆道手术采用静脉吸入复合全麻能有效减少胆心反射和心跳骤停的发生，因此认为胆道手术(尤其老年患者)采用以静脉吸入复合全麻为主的麻醉方法可减少围麻醉期并发症。

Comparition of the methods of epidural and total introvenous combined inhalation anesthesin in cholecystectomy

Objective\ To compare the methods of epidural and total introvenous combined inhalation anesthesin in the patients undergoing cholecystectomy in order to reduce the rate of cardiac arrest.Methods\ The operations were performed under fentany propofol and isoflurane anesthesia in the general anesthesia group.1% lidocaine and 0 375% bubivacaine were used in the epidural anesthesia group.Statistic analysis was according to the rate of cholecyst cardiac reflex and cardiac arrest.Results\ There were no patients with cardiac arrest in the total introvenous combined inhalation and cholecyst cardiac reflex rate was only 10%.Cardiac arrest rate was 0 62% and cholecyst cardiac reflex rate was 42 5% in the epidural anesthesia group.Conclusion\ The rate of cardiac arrest would be obviously reduced with total introvenous combined inhalation anesthesia compared to epidural anesthesia in the cholecystectomy.