气管内硬膜外联合麻醉下的超前镇痛_医学论文.docVIP

气管内硬膜外联合麻醉下的超前镇痛_医学论文 气管内硬膜外联合麻醉下的超前镇痛_医学论文 作者：叶西就，曹德雄，彭 俊，梁建军，苗利萍，曹铭辉，彭书崚 【摘要】 目的 研究气管内硬膜外联合麻醉下，硬膜外给药时间不同、全麻诱导药物不同对术后镇痛产生的影响。方法 开腹行切除肝癌、胃癌的病人120例，随机分为A、B、C、D 4组，每组30例。A组：在T8～9经硬膜外注入1%利多卡因和0.25%布比卡因混合液6～8ml，再经硬膜外注入含吗啡2mg、氟哌利多2.5mg的生理盐水10ml；全身麻醉诱导药物为芬太尼3μg/kg，异丙酚1～1.5mg/kg，琥珀胆碱2mg/kg。B组：诱导药物中不使用芬太尼，用利多卡因1～1.5mg/kg代替，术中也不使用芬太尼，其余条件同A组。C组：在T8～9行硬膜外穿刺，之后行全身麻醉诱导，诱导药物为芬太尼3μg/kg，异丙酚2～2.5mg/kg，琥珀胆碱2mg/kg，必要时可加芬太尼2～3μg/kg。切皮后90min， 经硬膜外注入1%利多卡因和0.25%布比卡因6～8ml，再经硬膜外注入含吗啡2mg、氟哌利多2.5mg的生理盐水10ml。D组：诱导药物中不使用芬太尼，用利多卡因1～1.5mg/kg代替，术中也不使用芬太尼，其余条件同C组。分别于术毕后4、8、24、48h观察视觉模拟评分（VAS）、镇痛药消耗量、恶心、呕吐、瘙痒等指标。结果 A组的药物消耗量最少、镇痛效果最好；B组和C组次之；D组的药物消耗量最大，镇痛效果最差。结论 硬膜外复合气管内麻醉时，硬膜外麻醉与芬太尼同时使用，术后镇痛效果最好。 【关键词】 超前镇痛；芬太尼；硬膜外麻醉；气管内麻醉 【Abstract】 Objective To study the influence of epidural anaesthesia in different time and different induced drugs of general anaesthesia on postoperative analgesia under general anesthesia combined with epidural anaesthesia.Methods 120 patients of performing hepatoma and carcinoma of stomach are divided randomly into A，B，C，D group，30 patients in each group. Group A：1% lidocaine and 0.25% bupivacaine 6～8 ml were infused into epidural space at T8～9，followed by 10 ml normal saline containing morphine 2mg and droperidol 2.5mg：Induced drugs of general anaesthesia were fentanyl 3μg/kg，propofol 1～1.5mg/kg，succinycholine 2mg/kg.Group B： fentanyl was not used in induction and maintenance of general anesthesia and replaced by lidocaine 1～1.5mg/kg，other conditions were similar to group A. Group C：After epidural puncture at T8～9， Induced drugs of general anaesthesia were fentanyl 3μg/kg，propofol 2～2.5mg/kg，succinycholine 2mg/kg，fentanyl was used if necessary. After 90 minutes of incision，1% lidocaine and 0.25% bupivacaine 6～8 ml were infused into epidural space at T8～9，followed by 10 ml normal saline containing morphine 2mg and droperidol 2.5mg.Group D：fentanyl was not used in induction and during operation，which being replaced by lidocaine 1～1.5mg/kg in induction：other conditions were