胸段硬膜外阻滞复合全麻中轻度低温的临床观察

The Mild Hypothermia During Thoratic Epidural Block Combined With General Anesthesia and its effect on the Cold Stress During the Recovery of Anesthesia

目的:研究胸段硬膜外阻滞复合全身麻醉中轻度低温的形成规律及其对麻醉恢复期寒冷应激反应的影响。方法:选择ASAⅠ-Ⅱ食管癌根治术患者20例,均采用胸段硬膜外阻滞复合全身麻醉。诱导前20min开始每间隔10min记录鼓膜温度。观察记录所有患者术后1h时的热舒适度评分和术后3h内的寒战反应发生情况。结果:麻醉诱导后鼓膜温度呈进行性降低趋势,鼓膜温度的降温速度、降低值在各时间点之间的差异有统计学意义(P<0.05)。术后1h时的热舒适度评分为25±8,术后3h内有13例患者发生了寒战反应。结论:胸段硬膜外阻滞复合全身麻醉中会导致轻度低温,麻醉后第1h降温较快,此后相对缓慢但仍呈持续性下降趋势。轻度低温可导致术后寒战和寒冷不适感。

Objective: To study the changing pattern of mild hypothermia during thoratic epidural block combined with general anesthesia and assess its effect on the cold stress during the recovery of anesthesia. Methods: Twenty patients ASA I ~ II undergoing elective surgery for carcinoma of oesophagus were enrolled in this study. Epidural block was performed at T7-8. General anesthesia was induced with fentanyl 3 μg/kg, thiopentone 3 ~5 mg/kg and succinylcholine 1.5 mg/kg. Anesthesia was maintained with isoflu-rane, vecuronium and thoracic epidural block. Bispectral index (BIS) was maintained at 45 -60. Tympanic temperature was recorded perioperatively every 10 min. from 20 min before induction Incidence of shivering within 3h and thermal comfort scale at 1h postoperation were assessed. Results: Tympanic temperature decreased progressively during combined anesthesia and there was significant difference among their speed and value(P < 0. 05). Thirteen patients shivered within 3 h after operation. The thermal comfort scale at 1 h postoperation was (25 ± 8). Conclusion: Mild hypothermia developed progressively during thoracic epidural block combined with general anesthesia, tympanic temperature decreased at a higher rate during the first hour than the following hours. Mild hypothermia may result in postoperative shivering and severe cold thermal discomfort.