两种麻醉方式下上腹部手术患者围术期能量代谢和呼吸氧价变化的比较

The effects of two anesthetic regimens on energy metabolism and oxygen cost of breathing

目的 观察两种麻醉方式下上腹部手术患者围术期能量代谢和呼吸氧价的变化,并探讨其机制。方法选择择期行上腹部手术患者40例,ASAⅡ级,年龄42-61岁,体重42-75kg。随机分为两组,每组20例,Ⅰ组采用硬膜外阻滞复合全身麻醉,Ⅱ组采用全凭静脉复合麻醉。用代谢监测仪分别于麻醉前、麻醉手术中和麻醉清醒后进行代谢测定。结果 两组患者麻醉后手术中的氧耗量(VO2)、二氧化碳产生量(VCO2)、能量消耗(EE)均低于麻醉前,而呼吸商(RQ)高于麻醉前(P<0.05);Ⅰ组患者手术后VO2、VC2、EE、RQ的变化无统计学意义(P>0.05);Ⅱ组患者手术后VO2、VCO2、EE均高于麻醉前(P<0.05),RQ明显低于麻醉前(P<0.05),与Ⅰ组比较,Ⅱ组患者术后VO2、VCO2、EE均升高,RQ降低(P<0.05);Ⅱ组患者呼吸氧价明显高于Ⅰ组患者(P<0.05)。结论 与全凭静脉麻醉比较,硬膜外阻滞复合全麻能够减少术后的能量代谢,降低呼吸氧价。

Objective To compare the effects of combined general-epidural anesthesia (CGEA) and general anesthesia (GA) on energy metabolism and oxygen cost of breathing.Methods Forty patients (25 male, 15 female) aged 42-61 yr weighing 42-75 kg scheduled for elective upper abdominal surgery were randomly divided into 2 groups : group CGEA (Ⅰ, n = 20) and group GA (Ⅱ, n = 20) . The patients were premedicated with midazolam 0.05 mg·kg-1 and scopolamine 0.3 mg i.m. . In groupⅠepidural catheter was placed at T9-10 A. test dose of 4ml of 2 % lidocaine was given. When the height of block was confirmed general anesthesia was started. In both groups anesthesia was induced with etomidate 0.3 mg·kg-1 , fentanyl 8 μg·kg-1 and tracheal intubation was facilitated with atracurium 0.8 mg·kg-1 . Anesthesia was maintained with propofol in both group and intermittent epidural lidocaine in CGEA group and intermittent i. v. boluses of fentanyl in GA group. Muscle relaxation was maintained with atracurium infusion at 8 μg·kg-1 · min-1 during operation. Oxygen consumption ( VO2 ), CO2 production (VCO2 ) , energy expenditure ( EE) and respiratory quotient (RQ) were measured before anesthesia, during and after operation using indirect calorimetry (Datex, Deltatrac MBM-200) . Postoperative oxygen cost of breathing (OCB) was calculated during spontaneous breathing and controlled ventilation. Results VO2 , VCO2 , EE were significantly lower and RQ was significantly higher during operation than those before anesthesia in both groups (P < 0.05) . In group CGEA VO2, VCO2 , EE were lower and RQ was higher after operation than the baseline values before anesthesia but the difference was not statistically significant, while in group GA VO2 , VCO2 , EE were significantly higher and RQ was significantly lower after operation than the preanesthetic values (P < 0.05) . OCB was significantly higher in GA group than that in group CGEA. Conclusion The CGEA attenuates stress response during and after operation and reduces energy metabolism and oxygen cost of breathing.