胸段硬膜外阻滞复合全身麻醉中鼓膜温和直肠温的变化

Changing Pattern of Core Temperature during Thoracic Epidural Block Combined with General Anesthesia and the Agreement between Rectal and Tympanic Temperature

目的 研究胸段硬膜外阻滞复合全身麻醉中鼓膜温和直肠温的变化规律 ,并以鼓膜温为标准中心体温 ,比较直肠温用于临床监测中心体温的有效性。方法 选择食管癌根治术患者 10例 ,均采用胸段硬膜外阻滞复合全身麻醉。诱导前 2 0min开始每间隔 10min记录鼓膜温 ,诱导后开始每间隔 10min记录直肠温。结果 麻醉诱导后鼓膜温呈进行性降低趋势 ,鼓膜温的降温速度和降低值在各时间点之间的差异有统计学意义 (P <0 .0 1) ;直肠温与鼓膜温之间有良好的相关性。结论 胸段硬膜外阻滞复合全身麻醉下中心体温会进行性降低 ,麻醉后第 1小时降温较快 ,此后相对缓慢但仍持续下降 ;直肠温可反映鼓膜温的变化趋势 ,但它比鼓膜温要偏高。

Purpose To study the changing pattern of core temperature during thoracic epidural block combined with general anesthesia and assess the agreement between rectal and tympanic temperature. Methods Ten ASA Ⅰ～Ⅱ patients undergoing elective surgery for carcinoma of oesophagus were enrolled in this study.Epidural block was performed at T 7～8.General anesthesia was induced with fentanyl 3 μg/kg,thiopentone 3～5 mg/kg and succinylcholine 1.5 mg/kg.Anesthesia was maintained with isoflurance,vecuronium and thoracic epidural block.Bispectral index(BIS) was maintained at 45～60.Tympanic and rectal temperature were recorded perioperatively every 10 min. Results Tympanic temperature decreased progressively during combined anesthesia and decreased (1.34±0.27),(1.91±0.33) and (2.39±0.44) ℃ within 1,2 and 3 hours,respectively.There was significant difference among these time points(P<0.01).The decreasing rate of tympanic temperature was (1.33±0.13),(0.54±0.17) and (0.48±0.19) ℃/h during the first,second and third hour,respectively.Rectal temperature correlated well with tympanic temperature and the coefficient of determination (R2) was 0.95.The bias for rectal temperature compared with tympanic temperature was (0.52±0.16) ℃( x—±s). Conclusions Perioperative mild hypothermia develops progressively during thoracic epidural block combined with general anesthesia,tympanic temperature decreases at a higher rate during the first hour than that of the following hours.Rectal temperature can reflect the changing trends of tympanic temperature,but it is a little higher than tympanic temperature.