硬膜外阻滞复合浅全麻在上腹部复杂手术中临床应用.docVIP

硬膜外阻滞复合浅全麻在上腹部复杂手术中临床应用 　【关键词】 硬膜外阻滞 　　【摘要】 目的 观察硬膜外阻滞复合浅全麻对复杂上腹部手术病人血流动力学及血糖的影响。方法 随机将复杂上腹部手术病人48例分为两组，各24例，研究组行硬膜外穿刺置管并注入局麻药，成功后用咪唑安定0.1mg/kg，芬太尼4μg/kg，异丙酚4mg/kg和阿曲库铵0.2mg/kg诱导行气管插管，用异氟醚吸入和异丙酚4mg/（kg#12539;h）恒速输注维持麻醉，对照组仅为单纯气管插管全麻，分别监测全麻诱导前、麻醉诱导插管后、切皮后、手术探查后、术毕拔管后的血流动力学及血糖变化，观察两组全麻药用量情况。结果 研究组全麻药用量较对照组明显减少（P＜0.05或＜0.01），血糖在麻醉及手术过程中变化不明显，拔管后升高，但升高值明显低于对照组（P＜0.01），血流动力学变化研究组变化幅度小，相对较稳定。结论 硬膜外阻滞复合浅全麻对复杂上腹部手术血流动力学和血糖等影响较小，术后全麻药用量少，可获得理想的术后镇痛，为安全合理的麻醉方法。 　　【关键词】 硬膜外阻滞；全身麻醉；血流动力学现象；血糖 　　Clinical study on thoracic epidural anesthesia plus light general anesthesia in complicated upper abdominal operation 　　【Abstract】 Objective To evaluate clinical efficacy of thoracic epidural anesthesia plus light general anesthesia in complicated upper abdominal operation.Methods 48 cases undergoing complicated procedures were allocated to one of the two groups at random（n=48）.Study group（n=24） were induced with fentanyl 4μg/kg,midaxloam 0.1mg/kg,propofol 4mg/kg and atracurium 0.2mg/kg after succeeding in puncturing putting and managing epidural anesthetia.Keep anesthesia by isoflurane inhalation and propofol 4mg/（kg#12539;h）iv constantly.Control group（n=24） was light general anesthetized only monitoring the hemodynamics before and after induced anesthesia,after cutting covers,exploratory operation and when the operation finished.The whole anesthetic consumption,the hemodynamic phenomena and the glucose changing were analyzed.Results Study group was significantly lower with regard to the whole anesthetic consumption,the hemodynamics and the blood glucose kept stead（P＜0.05 or ＜0.01）.Conclusion Thoracic epidural anesthesia plus light general anesthesia for complicated upper abdominal operation is a reasonable approach to anesthesia. 　　【Key words】 anesthesia,epidural;general anesthesia;hemodynamic phenomena;blood glucose 　　气管插管全麻因其控制呼吸、纯氧吸入、肌松效果较好、安全性高而广泛应用于临床，但它不能很好地控制应激反应，给术后血流动力学的稳定及肺功能的恢复造成不利影响，而且用药量较大，术后苏醒较慢，拔管延迟，术后不能通过硬膜外导管获得理想的术后镇痛。我院对48例上腹部较大手术采用硬膜外阻滞复合浅全麻，较好地克服了单独使用全麻的缺点，效果满意。现报