CAJ | 학술논문

目的：探讨行开胸术式的高血压患者开展全身麻醉联合硬膜外阻滞的临床疗效及安全性。方法选取2011年1月至2014年4月收治的78例行开胸手术治疗的高血压患者，利用随机数字表法进行分组，设为研究组和对照组，每组39例。两组患者均行全身麻醉处理，其中研究组在此基础上实施硬膜外阻滞。记录两组患者于麻醉前、切皮后10 min、1 h 及气管拔管后5 min 的血清皮质醇、血管紧张素Ⅱ、心率、血压及中心静脉压值，并比较两组并发症发生率。结果两组手术时间差异无统计学意义（ P ﹥0.05）；研究组咪唑安定使用剂量高于对照组（ P ﹤0.05），芬太尼、阿曲库铵、七氟醚及丙泊酚使用剂量低于对照组（ P ﹤0.05）。两组在麻醉前的血清皮质醇、血管紧张素Ⅱ、心率、血压及中心静脉压数值差异无统计学意义（ P ﹥0.05），研究组在切皮后10 min、切皮后1 h 及气管导管拔管后5 min 的血清皮质醇、血管紧张素Ⅱ、心率、血压及中心静脉压数值均低于对照组（ P ﹤0.05）。研究组围手术期并发症发生率为5.1%（2/39），对照组并发症发生率为35.9%（14/39），差异有统计学意义（ P ﹤0.05）。结论全麻复合硬膜外阻滞应用于高血压开胸手术患者，能有效降低机体应激反应，改善循环状态，且能降低围手术期并发症，取得较为满意的临床效果。
목적：탐토행개흉술식적고혈압환자개전전신마취연합경막외조체적림상료효급안전성。방법선취2011년1월지2014년4월수치적78례행개흉수술치료적고혈압환자，이용수궤수자표법진행분조，설위연구조화대조조，매조39례。량조환자균행전신마취처리，기중연구조재차기출상실시경막외조체。기록량조환자우마취전、절피후10 min、1 h 급기관발관후5 min 적혈청피질순、혈관긴장소Ⅱ、심솔、혈압급중심정맥압치，병비교량조병발증발생솔。결과량조수술시간차이무통계학의의（ P ﹥0.05）；연구조미서안정사용제량고우대조조（ P ﹤0.05），분태니、아곡고안、칠불미급병박분사용제량저우대조조（ P ﹤0.05）。량조재마취전적혈청피질순、혈관긴장소Ⅱ、심솔、혈압급중심정맥압수치차이무통계학의의（ P ﹥0.05），연구조재절피후10 min、절피후1 h 급기관도관발관후5 min 적혈청피질순、혈관긴장소Ⅱ、심솔、혈압급중심정맥압수치균저우대조조（ P ﹤0.05）。연구조위수술기병발증발생솔위5.1%（2/39），대조조병발증발생솔위35.9%（14/39），차이유통계학의의（ P ﹤0.05）。결론전마복합경막외조체응용우고혈압개흉수술환자，능유효강저궤체응격반응，개선순배상태，차능강저위수술기병발증，취득교위만의적림상효과。
Objectine To explore the clinical effectiveness and safety in patients with essential hypertension thoracotomy of the develop-ment of general anesthesia combined with epidural anesthesia. Methods 78 patients undergoing thoracic surgery in the treatment of hypertensive patients from January 2011 to April 2014 admitted to our hospital. 78 cases were divided into study group and control group using randomly group-ing method,each group had 39 cases. Two groups of patients underwent general anesthesia,the research group received the implementation of epi-dural block. 10 min after skin incision,1h after tracheal extubation of serum cortisol and 5min angiotensin II,heart rate,blood pressure and cen-tral venous pressure value were recorded in the two groups of patients before anesthesia,these indexes were compared between the two groups the incidence of complications. Results There were no significant differences between two groups in operation time( P ﹥ 0. 05);the study group with midazolam dose was higher than that of the control group( P ﹤ 0. 05). The fentanyl and atracurium,isoflurane and 1% procaine dosage was lower than that of the control group( P ﹤ 0. 05). In the two groups before anesthesia,serum cortisol and angiotensin Ⅱ,heart rate,blood pres-sure and central venous pressure had no significant difference( P ﹥ 0. 05),the study group 10 min and 1 h after skin incision in the skin incision and after tracheal extubation after serum cortisol,5 min angiotensin II,heart rate,blood pressure and central venous pressure values were lower than the control group( P ﹤ 0. 05). Study group the incidence of perioperative complications was 5. 1%(2 / 39),the control group the incidence of complications was 35. 9%(14 / 39),the difference was statistically significant( P ﹤ 0. 05). Conclusion The application of general anesthe-sia combined with epidural anesthesia in hypertension patients undergoing thoracic surgery,can effectively reduce the stress response,improve cir-culation,and can reduce the perioperative complications,clinical results obtained satisfactory.