中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2011年
12期
13-15
,共3页
镇痛,硬膜外%麻醉%手术后并发症
鎮痛,硬膜外%痳醉%手術後併髮癥
진통,경막외%마취%수술후병발증
Analgesia,epidural%Anesthesia%Postoperative complication
目的 比较硬膜外联合全身麻醉(CEGA)和全凭静脉麻醉(TTVA)在腹腔镜胆囊切除术中的有效性和安全性.方法 将40例择期行腹腔镜胆囊切除术患者按随机数字表法分为CEGA组和TIVA组,每组20例.比较两组患者的血压、心率、脉搏血氧饱和度、Steward评分、疼痛评分及不良反应.结果 CEGA组术后4、6min时Steward评分[(4.5±0.6)、(5.7±0.2)分]明显高于TTVA组[(2.8±0.4)、(4.1±0.5)分](P＜0.05).CEGA组术后2、3、4 h疼痛评分[分别为(1.8±0.3)、(1.5±0.4)、(1.7±0.3)分]明显低于TTVA组[分别为(3.2±0.5)、(3.7±0.4)、(4.2±0.6)分](P＜0.05).两组术后腹部疼痛、肩部疼痛及不良反应发生率比较差异均无统计学意义(P＞0.05).结论 在行腹腔镜胆囊切除术时CEGA比TTVA效果好,也更安全.CEGA可以减少由CO2引起的腹膜激惹现象,可以有效地减轻术中及术后的疼痛,缩短术后苏醒时间,且未增加不良反应发生率.
目的 比較硬膜外聯閤全身痳醉(CEGA)和全憑靜脈痳醉(TTVA)在腹腔鏡膽囊切除術中的有效性和安全性.方法 將40例擇期行腹腔鏡膽囊切除術患者按隨機數字錶法分為CEGA組和TIVA組,每組20例.比較兩組患者的血壓、心率、脈搏血氧飽和度、Steward評分、疼痛評分及不良反應.結果 CEGA組術後4、6min時Steward評分[(4.5±0.6)、(5.7±0.2)分]明顯高于TTVA組[(2.8±0.4)、(4.1±0.5)分](P＜0.05).CEGA組術後2、3、4 h疼痛評分[分彆為(1.8±0.3)、(1.5±0.4)、(1.7±0.3)分]明顯低于TTVA組[分彆為(3.2±0.5)、(3.7±0.4)、(4.2±0.6)分](P＜0.05).兩組術後腹部疼痛、肩部疼痛及不良反應髮生率比較差異均無統計學意義(P＞0.05).結論 在行腹腔鏡膽囊切除術時CEGA比TTVA效果好,也更安全.CEGA可以減少由CO2引起的腹膜激惹現象,可以有效地減輕術中及術後的疼痛,縮短術後囌醒時間,且未增加不良反應髮生率.
목적 비교경막외연합전신마취(CEGA)화전빙정맥마취(TTVA)재복강경담낭절제술중적유효성화안전성.방법 장40례택기행복강경담낭절제술환자안수궤수자표법분위CEGA조화TIVA조,매조20례.비교량조환자적혈압、심솔、맥박혈양포화도、Steward평분、동통평분급불량반응.결과 CEGA조술후4、6min시Steward평분[(4.5±0.6)、(5.7±0.2)분]명현고우TTVA조[(2.8±0.4)、(4.1±0.5)분](P＜0.05).CEGA조술후2、3、4 h동통평분[분별위(1.8±0.3)、(1.5±0.4)、(1.7±0.3)분]명현저우TTVA조[분별위(3.2±0.5)、(3.7±0.4)、(4.2±0.6)분](P＜0.05).량조술후복부동통、견부동통급불량반응발생솔비교차이균무통계학의의(P＞0.05).결론 재행복강경담낭절제술시CEGA비TTVA효과호,야경안전.CEGA가이감소유CO2인기적복막격야현상,가이유효지감경술중급술후적동통,축단술후소성시간,차미증가불량반응발생솔.
Objective To compare the efficacy and safety of combined epidural/general anesthesia (CEGA) versus total intravenous anesthesia (TIVA) for laparoscopic cholecystectomy. Methods Forty patients were assigned to group TIVA and group CEGA by random digits table with 20 cases in each. The systolic and diastolic arterial pressure,heart rate, oxygen saturation,Steward score, visual analogue scale (VAS) score and adverse reaction were monitored. Results Steward score 4,6 min after operation in group CEGA [(4.5 ±0.6), (5.7 ±0.2) scores] was higher than that in group TIVA [(2.8 ±0.4), (4.1 ±0.5)scores](P ＜ 0.05 ). The VAS score 2,3,4 h after operation in group CEGA [( 1.8 ± 0.3 ), (1.5 ± 0.4), (1.7±0.3 ) scores] was lower than that in group TIVA [( 3.2 ± 0.5 ), ( 3.7 ± 0.4), (4.2 ± 0.6) scores] (P＜0.05 ).There was no significant difference in abdomen pain, shoulder pain and adverse reaction between two groups.The incidence of postoperative side effects was lower in both groups (P ＞ 0.05). Conclusions The use of CEGA for laparoscopic cholecystectomy seems to be effective and safe, and to offer some advantages as compared to TIVA alone. CEGA can control pain due to CO2-induced peritoneal irritation, provide excellent infra-operative and postoperative analgesia. CEGA does not require the use of intraoperative intravenous opioids and shortens recovery time, without increasing the incidence of adverse reaction.
