CAJ | 학술논문

目的：评估左布比卡因硬膜外复合全身麻醉对结肠手术的影响。方法：择期行结肠癌手术的60例患者随机、双盲分为4组，对照组（S组）、0．125％左布比卡因组（L1组）、0．25％左布比卡因组（L2组）及0．5％左布比卡因组（L3组），各15例。S组硬外注射首量生理盐水10 mL，随后5 mL／h泵注至术毕，L1、L2、L3组则选用左布比卡因。硬膜外穿刺后行麻醉诱导，记录入室5 min、插管1 min、切皮、探查、开刀1 h、术毕、拔管、离开复苏室八个时点的平均血压、心率，并测血糖、皮质醇，记录麻醉时间、复苏室时间，出血量、输液量、不良反应，异丙酚、瑞芬太尼、麻黄素、芬太尼总量。结果：S组复苏时间长于其他3组，L1组瑞芬太尼、芬太尼大于L2、L3组，L3组麻黄素大于其他3组；L1组血糖高于L2、L3组，皮质醇高于L3组，L3组低血压例数高于其他3组。结论：0．25％左布比卡因硬膜外输注可减少应激反应，节俭阿片药物，减少复苏时间，不增加麻黄素使用。
목적：평고좌포비잡인경막외복합전신마취대결장수술적영향。방법：택기행결장암수술적60례환자수궤、쌍맹분위4조，대조조（S조）、0．125％좌포비잡인조（L1조）、0．25％좌포비잡인조（L2조）급0．5％좌포비잡인조（L3조），각15례。S조경외주사수량생리염수10 mL，수후5 mL／h빙주지술필，L1、L2、L3조칙선용좌포비잡인。경막외천자후행마취유도，기록입실5 min、삽관1 min、절피、탐사、개도1 h、술필、발관、리개복소실팔개시점적평균혈압、심솔，병측혈당、피질순，기록마취시간、복소실시간，출혈량、수액량、불량반응，이병분、서분태니、마황소、분태니총량。결과：S조복소시간장우기타3조，L1조서분태니、분태니대우L2、L3조，L3조마황소대우기타3조；L1조혈당고우L2、L3조，피질순고우L3조，L3조저혈압례수고우기타3조。결론：0．25％좌포비잡인경막외수주가감소응격반응，절검아편약물，감소복소시간，불증가마황소사용。
Objective To evaluate the impact of epidural anesthesia with levobupivacaine combined with general anesthesia on colon surgery. Methods Sixty patients undergoing elective radical procedure for colon carcinoma were randomLy divided into four groups: saline group (group S), 0.125% levobupivacaine group (group L1), 0.25% levobupivacaine group (group L2), and 0.5% levobupivacaine group (group L3). Group S received normal saline of 10 mL epidurally and then infusion of 5 mL·h-1 until the procedure was finished; groups L1, L2, and L3 received levobupivacaine instead. Anesthetic induction was performed after epidural puncture. Mean blood pressure and heart rate were recorded at 8 time points including 5 min after entering into the operation room, 1 min after intubation, skin incision, abdominal exploration, 1 h after skin incision, completion of operation, extubation, and leaving PACU; meanwhile blood glucose and cortisol were detected, anesthesia time, time to PACU stay, bleeding, transfusion volume, adverse reaction, and doses of propofol, remifentanil, ephedrine, and fentanyl were noted. Results Time to PACU stay was longer in S group than in other 3 groups. Doses of remifentanil and fentanyl were larger in L1 group than in L2 group and L3 group. Ephedrine dose in L3 group was larger than in other 3 groups. Blood sugar in L1 group was higher than L2 group and L3 group. Cortisol in S group was higher than in other 3 group. Cortisol in L1 group was higher than in L3 group. The number of patients with hypotension was greater in L3 group than other 3 groups. Conclusions Continue epidural infusion of 0.25%levobupivacaine can reduce stress response and opioid uses, shorten PACU stay, whereas it does not increase use of ephedrine.