胰肾联合移植术麻醉方法的选择

目的 探讨适合胰肾联合移植手术的麻醉方法。方法 选择30例胰肾联合移植的患者，根据其术中麻醉方法分为硬膜外阻滞复合持续静脉镇静麻醉（EA组）和静脉输注联合吸入复合全身麻醉（GA组），每组15例。观察各组患者的手术时间、液体出入量、以及血管活性药、葡萄糖和胰岛素的用量，监测术中的心电图（ECG）、血氧饱和度（SpO2）、平均动脉压（MAP）、中心静脉压（CVP）、动脉血气和血糖水平，术后观察移植物功能和肺部并发症。结果 胰肾联合移植术中，EA组胰岛素用量较GA组少，但其葡萄糖及血管活性药物的用量较GA组多（P〈0．05）；EA组术中血流动力学波动较大，与GA组比较，差异有统计学意义（P〈0．05）。EA组术后有5例患者发现明显的肺部并发症，GA组有8例。EA组有8例患者术后1d内使用胰岛素，而GA组仅有4例。结论 胰肾联合移植手术中选择连续硬膜外阻滞复合静脉镇静麻醉，可减少术后肺部并发症，有利于胰腺功能的恢复，但须注意其对血流动力学的影响。

Anesthetic choice for patients undergoing simultaneous pancreas-kidney transplantation

Objective To study how to select epidual blockade with intravenous sedation and general anesthesia for patients undergoing simultaneous pancreas-kidney transplantation. Methods Thirty diabetic patients suffered from end-stage renal failure undergoing simultaneous pancreas-kidney transplantation were divided into two groups (15 cases in each group): group GA and group EA. BP, HR, CVP, SpO2 and PET CO2 were continuously monitored during operation. Arterial blood samples were taken for analysis of arterial blood gas. Postoperative pulmonary complications and function of transplanted pancreas were observed closely. Results Compared with group EA, blood glucose levels were higher and the usage of insulin was more in group GA. However, fewer glucose supply was given after reperfusion. Hemodynamics in group GA was more stable than that in group EA. Pulmonary complications and patients required insulin therapy were less in group EA than in group GA. Conclusions Compared with general anesthesia, epidual anesthesia combined with continuous sedation is of great advantage to rehabilitation of pancreas grafts, and leads to less pulmonary complications, but can cause slight hemodynamics unstability.