全麻与全麻复合硬膜外阻滞用于开胸手术的对比研究

目的比较全麻与全麻复合硬膜外阻滞用于开胸手术时对血流动力学、全麻药用量、术后苏醒情况及镇痛效果的影响.方法随机将48例ASAⅠ～Ⅱ级择期开胸手术病人分为全麻组(A组)与全麻复合硬膜外阻滞组(B组).A组采用氟芬合剂、依托咪脂和维库溴铵静脉注射诱导,芬太尼、氨氟醚及维库溴铵维持麻醉.B组则先行T7～8硬膜外腔穿刺置管,观察无全脊髓麻醉征象和待阻滞平面出现后,采用与A组相同的方法诱导气管内插管;麻醉维持方法同A组,但术中每隔1h经硬膜外导管间断给予1.5%利多卡因5ml.观察麻醉前、气管插管时、切皮时、拔除气管导管时的平均动脉压(MAP)、心率(HR)和血氧饱和度(SpO2)、术中用药情况、术毕至拔除气管导管时间及术后24h随访情况.结果(1)与全麻相比较,全麻复合硬膜外阻滞组病人手术期平均动脉压、心率平稳,差异非常显著(P＜0.01);(2)全麻复合硬膜外阻滞组全麻药和肌松药用量少于全麻组,清醒时间和拔管时间明显缩短(P＜0.01);(3)全麻复合硬膜外阻滞组病人术毕到疼痛开始时间比较长,术后镇痛效果优于全麻组(P＜0.01).结论全麻复合硬膜外阻滞应用于开胸手术优越于全麻.

Comparison of general anesthesia and general anesthesia combined with epidural block in thoracotomy

Objective To analyse the advantages of combined epidural block and general anesthesia versus general anesthesia in thoracotomy.Methods Fourty-eight patients scheduled for thoracic surgery were randomly divided into two groups. First group of patients (group A,n=24) was treated only with standard general anesthesia, and second group of patients (group B, n=24) was received general anesthesia combined with epidural block. Mean arterial blood pressure(MAP), heart rate(HR), transcutaneous oxygen saturation(SpO 2 ), used anesthetic doses, time to waking up and postoperative analgesia as the evaluation variables were determined in the study.Results In group B, MAP and HR were kept more stable, the anesthetic doses uesed in the operation and the time of waking up were significantly decreased. The effects of postoperative analgesia were better in group B as compared with that in group A.Conclusion Compared with routine general anesthesia, general anesthesia with epidural block for thoracic surgery can help to maintain stable the hemodynamics, reduce the anesthetic doses and postoperative recovery time, improve the effects of the postoperative analgesia.