硬膜外麻醉在胸腔镜下行肺大疱切除术中的麻醉效果

目的观察硬膜外麻醉用于胸腔镜肺大疱切除术的麻醉效果及不良反应。方法回顾性分析本院2010年11月～2012年12月行电视胸腔镜下肺大疱切除术80例,随机分为硬膜外麻醉组（TEA组,n=52）和全身麻醉单肺通气组（GA组,n=28）,TEA组采用硬膜外麻醉及术后硬膜外自控止痛泵,GA组采用全麻及术后静脉自控止痛泵,观察两组手术开始后15 min、手术结束后12 h的PaCO2。以视觉模拟评分（VAS）评价两组的术后镇痛效果。结果 TEA组的PaCO2在手术开始后15 min和手术结束后12 h分别为（48±5）mm Hg和（45±6）mm Hg,明显高于相应时间点GA组的（40±5）mm Hg和（38±5）mm Hg,差异有统计学意义（P〈0.05）。TEA组的VAS在术后即刻、术后12 h明显小于GA组的（P〈0.01）。结论硬膜外麻醉用于肺大疱患者的胸腔镜下肺大疱切除术简单可行,能够保证术中安全,提供满意的术中和术后镇痛,值得临床推广。

Anesthetic effect of epidural anesthesia in pulmonary bullae resection under the video-assisted thoracoscopic surgery

Objective To observe the anesthetic effect and its untoward effects of epidural anesthesia in pulmonary bullae resection treated with the video-assisted thoracoscopic surgery.Methods Eighty patients with pulmonary bullae resected under the video-assissted thoracoscopic surgery were reprospectively analyzed from November 2010 to De cember 2012,which were grouped as epidural anesthesia group（TEA group,n=52） and General anesthesia one-lung ventilation group（GA group,n =28） randomly,the patients of TEA group were treated with epidural anesthesia and epidural self-controlled analgesic pump after surgery,and the GA group were treated with general anesthesia and intra venous self-control analgesia pump after surgery.The level of PaCO2 of 15 minutes at the begin of operation and 12 hours after operation and the VAS grade were evaluted.Results The level of PaCO2 15 minutes at the begin of operation and 12 hours after operation in TEA group was（48±5） mm Hg and（45±6） mm Hg,were higher than（40±5） mm Hg and（38±5） mm Hg of GA group,the difference was signicant（P 0.05）;and the VAS grade of end point and 12 hours after operation in TEA group were lower than those of GA group（P 0.01）.Conclusion The epidural anesthesia used in pulmonary bullae resection under the video-assisted thoracoscopic surgery is safety and effective,which is worthy of popularizing.