国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2010年
1期
22-25
,共4页
胸段硬膜外%全身麻醉%开胸手术
胸段硬膜外%全身痳醉%開胸手術
흉단경막외%전신마취%개흉수술
Thoracic epidural anesthesia%General anesthesia%Thoracotomy
目的 比较胸段硬膜外复合静脉全麻与全凭静脉麻醉对开胸手术患者血流动力学、麻醉药维持剂量、术后苏醒、躁动及疼痛的影响.方法 64例择期行剖胸手术患者,ASA Ⅱ级～Ⅲ级,采用完全随机设计的方法分为2组.A组:胸段硬膜外复合静脉全麻组,患者预先用10 ml 0.25%布比卡因和0.1 mg芬太尼硬膜外给药.术中硬膜外0.25%布比卡因和芬太尼10μg/ml,5 ml/h复合丙泊酚维持.B组:全凭静脉麻醉组,丙泊酚-端芬太尼全凭静脉麻醉.观察并记录不同时间点2组心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、所需麻醉维持药量、术毕清醒及出现疼痛时间.结果 2组患者各观察点血流动力学变化比较,差异无统计学意义;胸段硬膜外复合静脉全麻组麻醉维持不需要静脉镇痛药瑞芬太尼和肌松药阿曲库铵,只需复合充分的丙泊酚镇静,就能满足手术需求;术后苏醒早;拔管时间(11±4)min,相对于全凭静脉麻醉组(23±16)min明显缩短(P<0.05):躁动例数显著减少;术后出现疼痛时间(7.4±2.6)min相对于全凭静脉麻醉组(0.5士0.3)min明显延长(P<0.01).结论 胸段硬膜外复合静脉全麻用于开胸手术快通道麻醉是一种安全、经济、有效并有利于患者术后恢复的麻醉方法.
目的 比較胸段硬膜外複閤靜脈全痳與全憑靜脈痳醉對開胸手術患者血流動力學、痳醉藥維持劑量、術後囌醒、躁動及疼痛的影響.方法 64例擇期行剖胸手術患者,ASA Ⅱ級～Ⅲ級,採用完全隨機設計的方法分為2組.A組:胸段硬膜外複閤靜脈全痳組,患者預先用10 ml 0.25%佈比卡因和0.1 mg芬太尼硬膜外給藥.術中硬膜外0.25%佈比卡因和芬太尼10μg/ml,5 ml/h複閤丙泊酚維持.B組:全憑靜脈痳醉組,丙泊酚-耑芬太尼全憑靜脈痳醉.觀察併記錄不同時間點2組心率(HR)、平均動脈壓(MAP)、中心靜脈壓(CVP)、所需痳醉維持藥量、術畢清醒及齣現疼痛時間.結果 2組患者各觀察點血流動力學變化比較,差異無統計學意義;胸段硬膜外複閤靜脈全痳組痳醉維持不需要靜脈鎮痛藥瑞芬太尼和肌鬆藥阿麯庫銨,隻需複閤充分的丙泊酚鎮靜,就能滿足手術需求;術後囌醒早;拔管時間(11±4)min,相對于全憑靜脈痳醉組(23±16)min明顯縮短(P<0.05):躁動例數顯著減少;術後齣現疼痛時間(7.4±2.6)min相對于全憑靜脈痳醉組(0.5士0.3)min明顯延長(P<0.01).結論 胸段硬膜外複閤靜脈全痳用于開胸手術快通道痳醉是一種安全、經濟、有效併有利于患者術後恢複的痳醉方法.
목적 비교흉단경막외복합정맥전마여전빙정맥마취대개흉수술환자혈류동역학、마취약유지제량、술후소성、조동급동통적영향.방법 64례택기행부흉수술환자,ASA Ⅱ급～Ⅲ급,채용완전수궤설계적방법분위2조.A조:흉단경막외복합정맥전마조,환자예선용10 ml 0.25%포비잡인화0.1 mg분태니경막외급약.술중경막외0.25%포비잡인화분태니10μg/ml,5 ml/h복합병박분유지.B조:전빙정맥마취조,병박분-단분태니전빙정맥마취.관찰병기록불동시간점2조심솔(HR)、평균동맥압(MAP)、중심정맥압(CVP)、소수마취유지약량、술필청성급출현동통시간.결과 2조환자각관찰점혈류동역학변화비교,차이무통계학의의;흉단경막외복합정맥전마조마취유지불수요정맥진통약서분태니화기송약아곡고안,지수복합충분적병박분진정,취능만족수술수구;술후소성조;발관시간(11±4)min,상대우전빙정맥마취조(23±16)min명현축단(P<0.05):조동례수현저감소;술후출현동통시간(7.4±2.6)min상대우전빙정맥마취조(0.5사0.3)min명현연장(P<0.01).결론 흉단경막외복합정맥전마용우개흉수술쾌통도마취시일충안전、경제、유효병유리우환자술후회복적마취방법.
Objective To compare thoracic epidural anesthesia (TEA)combined with general anesthesia (GA)and total-IV anesthesia (TIVA)with respect to haemodynamic differences, maintenance dosage of narcotic, recovery profile and postoperative pain.Methods Sixty-four patients, ASA physical status Ⅰ-Ⅲ undergoing thoracotomy were randomly allocated to two groups: thoracic epidural anesthesia(TEA)combined with general anesthesia (GA) group(group A) and total-IV anesthesia(TIVA) group(group B).Patients in the A group received 10 ml of 0.25% bupivacaine and fentanyl 0.1mg via the epidural route prior to skin incision, followed by an infusion of bupivacaine 0.25% and fentanyl 10 μg/ml at 5 ml/h. Group B received propofol target controlled infusion system and remifentanil. Results No statistically significant differences between the two groups with regards to the haemodynamic changes.Maintenance of anesthesia in TEA combined with GA group neither muscle relaxants nor opioid anesthetics were required. Extubate times were considerably shorter after TEA combined with GA (11±4) min in comparison with TIVA (23±16) min target controlled infusion system group (P<0.05). The emerge of postoperative pain time were considerably longer after TEA combined with GA (7.4±2.6) min in comparison with TIVA (0.5±0.3) min target controlled infusion system group (P<0.01). Conclusion Thoracic epidural anesthesia combined with general anesthesia for thoracotomy is rapid, safe, economic and effective method, moreover, in favor of the patients' postoperative recovery.
