全麻复合硬膜外阻滞在上腹部手术中的应用

A Clinical Study on Combined General Anesthesia with Epidural Block on Upper Abdominal Surgery

目的 观察全麻复合硬膜外阻滞在上腹部手术中的应用效果。方法 选 2 0例择期胃癌根治术或胆道探查术患者 ,随机分为全麻组 (对照组 )和全麻复合硬膜外组 (观察组 ) ,每组 10例。两组病人全麻诱导方法相同 ,观察组病人于全麻前行T8-9或T9-10 椎间隙硬膜外穿刺置管 ,局麻药用 2 %利多卡因 ,麻醉平面控制在T4以下 ,术中维持每 6 0min追加局麻药 1次 ,并吸入笑气和异氟醚。全麻组术中间断静注芬太尼和维库溴铵 ,并吸入笑气和异氟醚维持麻醉。对照组MAC控制在 1 3左右 ,观察组MAC控制在 0 . 8左右即可。结果 观察组芬太尼、维库溴铵用量及术中异氟醚吸入浓度明显低于对照组 (P <0 . 0 5 ) ,笑气吸入浓度无显著差异。两组病人术中均无知晓 ,对照组 2例病人拔管后躁动 ,而观察组无 1例发生。观察组术后止痛药物的用量明显少于对照组。结论 全麻复合硬膜外麻醉是一种值得推广的麻醉方法。

Objective To observe the effect of the general anesthesia combined with epidural block in the upper abdomen operation.Methods Twenty selective patients (ASA grade I to Ⅱ),who would be operated because of gastric carcinoma or biliary tract disease, were randomly divided into two groups general anesthesia group (G group)and general anesthesia combined with epidural block group(GE group).The same anesthesia agents were chosen to induce for all patients.The patients in GE group were punctured into epidural space though T 8-9 or T 9-10 inter vertebral space,and the duct was inserted towards head side.First dose 2% lidocaine was infused into the epidural space after test dose anesthesia plan. The anesthesia plan was under T 4 level. The minimal alveol concentration (MAC)of inhalational anesthetic agents of the patients was maintained about 1.3% in the G group and 0.8% in the GE group.Result The dose of vercurium and the inhalational concentration of isoflurane in GE group were lower than them in the G group in the operation (P<0.01).The dose of fentany and the inhalational concentration of nitrons oxide were not significantly different in two groups. Two patients were restlessness after the extubation in G group ,but none occured in GE group. Conclusions The general anesthesia combined epidural block is a good method and worth to spread. [