两种麻醉方法下控制性降压对胃粘膜pH及术后胃肠功能的.docVIP

两种麻醉方法下控制性降压对胃粘膜pH及术后胃肠功能的影响 王光磊 刘功俭*曹君利 曾因明 徐州医学院江苏省麻醉学重点实验室，江苏 徐州 221002； 徐州医学院附属医院麻醉科，江苏 徐州 221002 [摘要] 目的 观察两种麻醉方法下控制性降压对胃粘膜pH（pHi）及术后胃肠功能的影响，并探讨其影响机制。方法 选择ASAⅡ级、择期行肝癌手术病人30例，随机分为两组，E组病人采用硬膜外阻滞复合全身麻醉，G组采用静吸复合全身麻醉。用Tonocap监护仪分别于控制性降压前、降压后1h、降压后2h、停止降压后1h测定胃内PgCO2和pHi；同时在各时间点抽取动脉血行血气分析。结果 两组患者动脉血气分析指标无明显差别，但是pHi在控制性降压后1h、2h明显降低（P＜0.05），PgCO2在控制性降压后1h、2h明显升高（P＜0.05或P＜0.01），E组患者术后肛门排气、排便时间明显短于G组。结论 硬膜外阻滞复合全身麻醉在控制性降压时能够改善胃肠道血供，促进术后胃肠功能的恢复。 [关键词]：麻醉，硬膜外；麻醉，全身；控制性降压；胃粘膜 The effect of controlled hypotension on gastric intramucosal pH and the function of gastric-intestines after operation using two different anesthesia methods WANG Guang-lei,LIU Gong-jian,CAO Jun-li,et al.Department of Anesthesiology,Affiliated hospital, Xuzhou Medical college,Xuzhou 221002,China. [Abstract] objective To observe the effect of controlled hypotension on gastric intramucosal pH and the function of gastric-intestines after operation using two different anesthesia methods and to research its mechanism. Methods 30 patients(ASAⅡ) scheduled for ectomy of hepatocarcinoma,were randomly assigned to two groups as following:epidural block combined with general anesthesia group(E group) and inhalation anesthesia(G group). To measure gastric PgCO2 and pHi at the time spots of before controlled hypotension,after controlled hypotension 1h and 2h and after terminated controlled hypotension 1h respectively. At the same time the artery blood gas was measured. Results There wan no obvious differ in blood gas indexes between E group and G group. PHi decreased significantly at the time spots of after controlled hypotension 1h and 2h（P﹤0.05）, PgCO2 increased significantly at the time spots of after controlled hypotension 1h and 2h（P﹤0.05 or P﹤0.01）and the time of anus exhausting and defecating deferred significantly in G group patients, comparing E group ones. Conclusion epidural block combined with general anesthesia can improve gastric-intestines blood flow during controlled hypo