国际医药卫生导报
國際醫藥衛生導報
국제의약위생도보
INTERNATIONAL MEDICINE & HEALTH GUIDANCE NEWS
2012年
9期
1259-1261
,共3页
硬外镇痛%胸腔手术%苏醒期%躁动%瑞芬太尼
硬外鎮痛%胸腔手術%囌醒期%躁動%瑞芬太尼
경외진통%흉강수술%소성기%조동%서분태니
Epidural analgesia%Thoracic surgery%Recovery period of consciousness%Agitation%Remifentanil
目的 探讨硬膜外镇痛在胸腔手术后苏醒期的临床效果及安全性.方法 选择择期行剖胸肺大泡及单纯肺叶切除术90例,年龄25～55岁,ASAⅡ～Ⅲ级；将其随机分为硬外组(A),静脉组(B),对照组(C),每组30例.A组诱导前行T8～9硬膜外穿刺.三组均行双腔支气管插管,采用丙泊酚-瑞芬太尼-七氟醚静吸复合全身麻醉,维持PetCO2在35 ～ 45 mm Hg(1mm Hg=0.133 kPa)之间,血压波动在20％范围内.手术结束前20 min,A组硬膜外腔分次注入0.375％罗哌卡因10ml,B组静脉注射曲马多2mg/kg和昂丹思琼8 mg,C组静脉注射生理盐水10 ml.记录手术结束后自主呼吸恢复时间、意识恢复时间以及拔管时间.记录三组术前、清醒时和拔管后5 min的心率(HR)、平均动脉压(MAP)、呼吸频率(RR)、脉搏氧饱和度( SpO2).记录拔管后5min的镇痛,镇静及躁动评分.结果 A、B两组术后清醒时HR和MAP升高幅度均比C组小(P＜ 0.05),且A组比B组更低(P＜0.05).A组的疼痛评分和躁动评分最低(B＜C,P＜ 0.05;A＜B,P＜ 0.05).结论 硬膜外与静脉镇痛都能有效地抑制胸腔手术结束时停用麻醉药后苏醒期的各种不良反应,硬外镇痛效果更好.
目的 探討硬膜外鎮痛在胸腔手術後囌醒期的臨床效果及安全性.方法 選擇擇期行剖胸肺大泡及單純肺葉切除術90例,年齡25～55歲,ASAⅡ～Ⅲ級；將其隨機分為硬外組(A),靜脈組(B),對照組(C),每組30例.A組誘導前行T8～9硬膜外穿刺.三組均行雙腔支氣管插管,採用丙泊酚-瑞芬太尼-七氟醚靜吸複閤全身痳醉,維持PetCO2在35 ～ 45 mm Hg(1mm Hg=0.133 kPa)之間,血壓波動在20％範圍內.手術結束前20 min,A組硬膜外腔分次註入0.375％囉哌卡因10ml,B組靜脈註射麯馬多2mg/kg和昂丹思瓊8 mg,C組靜脈註射生理鹽水10 ml.記錄手術結束後自主呼吸恢複時間、意識恢複時間以及拔管時間.記錄三組術前、清醒時和拔管後5 min的心率(HR)、平均動脈壓(MAP)、呼吸頻率(RR)、脈搏氧飽和度( SpO2).記錄拔管後5min的鎮痛,鎮靜及躁動評分.結果 A、B兩組術後清醒時HR和MAP升高幅度均比C組小(P＜ 0.05),且A組比B組更低(P＜0.05).A組的疼痛評分和躁動評分最低(B＜C,P＜ 0.05;A＜B,P＜ 0.05).結論 硬膜外與靜脈鎮痛都能有效地抑製胸腔手術結束時停用痳醉藥後囌醒期的各種不良反應,硬外鎮痛效果更好.
목적 탐토경막외진통재흉강수술후소성기적림상효과급안전성.방법 선택택기행부흉폐대포급단순폐협절제술90례,년령25～55세,ASAⅡ～Ⅲ급；장기수궤분위경외조(A),정맥조(B),대조조(C),매조30례.A조유도전행T8～9경막외천자.삼조균행쌍강지기관삽관,채용병박분-서분태니-칠불미정흡복합전신마취,유지PetCO2재35 ～ 45 mm Hg(1mm Hg=0.133 kPa)지간,혈압파동재20％범위내.수술결속전20 min,A조경막외강분차주입0.375％라고잡인10ml,B조정맥주사곡마다2mg/kg화앙단사경8 mg,C조정맥주사생리염수10 ml.기록수술결속후자주호흡회복시간、의식회복시간이급발관시간.기록삼조술전、청성시화발관후5 min적심솔(HR)、평균동맥압(MAP)、호흡빈솔(RR)、맥박양포화도( SpO2).기록발관후5min적진통,진정급조동평분.결과 A、B량조술후청성시HR화MAP승고폭도균비C조소(P＜ 0.05),차A조비B조경저(P＜0.05).A조적동통평분화조동평분최저(B＜C,P＜ 0.05;A＜B,P＜ 0.05).결론 경막외여정맥진통도능유효지억제흉강수술결속시정용마취약후소성기적각충불량반응,경외진통효과경호.
Objective To explore the efficacy and safety of epidural analgesia in recovery period of consciousness in thoracic surgery.Methods 90 ASA Ⅱ - Ⅲ patients scheduled for lobectomy, aged 25 to 55 years, were randomly divided into epidural analgesia group ( group A ),intravenous analgesia group ( group B ),and control group ( group C ),30 for each group.Epidural acupunture was performed at T8-9 in group A before anesthesia induction.All the three groups received general anesthesia with remifentanil,propofol,and sevoflurane; PetCO2 was maintained between 35 and 45 mm Hg ( 1 mm Hg=0.133 kPa ) and blood pressure was controlled at a range of 20％.20 minutes before the end of surgery,group A was administered 0.375％ ropivacaine of 10 ml via the epidural space,group B received intravenous injections of tramadol of 2 mg/kg and ondansetron of 8 mg,and group C received 0.9％ NS of 10 ml.Time to recovery of spontaneous breathing,time to recovery of consciousness,and time to extubation were recorded.HR,MAP,RR,and SpO2 were noted preoperatively and at recovery of consciousness and 5 min after extubation.Levels of analgesia and agitation were scored 5 min after extubation.Results Levels of increased HR and MAP were lower in groups A and B than in group C at recovery period of consciousness,group A had the lowest level ( P ＜ 0.05 for all comparisons ).Pain scores and agitation scores were lowest in group A,followed by group B,and then group C ( P ＜ 0.05 for all comparisons ).Conclusions Both epidural and intravenous analgesia are effective in inhibition of various adverse reactions after termination of anesthetics.Epidural analgesia had a better efficacy.
