硬膜外应用舒芬太尼复合全身麻醉用于开胸手术降低静脉麻醉药物使用及提高麻醉效果的价值研究

Value of epidural sufentanil combined with general anesthesia in reducing intravenous anesthetic use and improving anesthetic effect in thoracotomy

目的:观察舒芬太尼硬膜外麻醉复合全身麻醉在开胸手术中的应用效果,及对降低麻醉药物使用量和提高麻醉效果的影响。方法:选取2016年8月~2018年8月在我院接受开胸手术的100例例患者为研究对象,并采用随机法将其分为3组,观察组(A组)采用硬膜外应用舒芬太尼复合全身麻醉,对照组1(B组)实施硬膜外应用罗哌卡因复合全身麻醉,对照组2(C组)实施单纯全身麻醉。观察三组患者麻醉药物使用量和血管活性药物使用情况,比较三组患者麻醉效果的差异。结果:三组患者丙泊酚使用量由高到低分别为C组、B组和A组,B组和C组患者血管活性药物使用率高于A组;三组患者麻醉前应激指标无差别,手术后2h,三组患者皮质醇、IL-6、TNF-α水平由高到低分别为C组、B组和A组;三组患者术后4h和术后12h的VAS得分由高到低分别为C组、B组和A组,三组患者术后Ramsay得分无差别;三组患者麻醉满意率由高到低分别为A组、B组和C组。结论:舒芬太尼硬膜外麻醉复合全身麻醉在开胸手术中的应用效果较好,可降低麻醉药物使用量,提高麻醉效果,具有良好的临床应用价值。

Objective To observe the effect of sufentanil epidural anesthesia combined with general anesthesia in thoracic surgery and its influence on reducing the use of anesthetics and improving the anesthetic effect.Methods 90 patients undergoing thoracotomy in our hospital from August 2016 to August 2018 were selected and randomly divided into three groups.The observation group (group A) was given epidural sufentanil combined with general anesthesia,the control group 1(group B) was given epidural ropivacaine combined with general anesthesia,and the control group 2(group C) was given epidural ropivacaine The use of narcotic drugs and vasoactive drugs in the three groups were observed,and the anesthetic effects of the three groups were compared.Results The propofol usage in group C,group B and group A was higher than that in group A.There was no difference in pre-anesthesia stress index among the three groups.Two hours after operation,the levels of cortisol,IL-6 and TNF-alpha in the three groups from high to low were divided into group C,group B and group A,respectively.The VAS scores of the three groups at 4 h and 12 h after operation were divided into group C,group B and group A,respectively.There was no difference in Ramsay scores among the three groups.The satisfaction rate of three groups of patients from high to low were A group,B group and C group respectively.Conclusion Sufentanil epidural anesthesia combined with general anesthesia in thoracic surgery has a good effect,can reduce the use of anesthetic drugs,improve anesthesia effect,has a good clinical application value.