全麻复合硬膜外阻滞在开胸手术中的应用

The application of general anesthesia combined with epidural block in patients undergoing thoracic surgery

目的 观察全麻复合胸段硬膜外阻滞在胸部手术患者血流动力学的变化、苏醒时间的影响。方法 40例ASAⅠ～Ⅱ级择期普胸手术病人，随机分为硬膜外阻滞复合全麻组（GA＋EA组）和单纯全麻组（GA组），每组20例。两组全麻诱导和维持方法相同，复合组在全麻诱导前先行胸段T4～5或T5～6硬膜外穿刺置管，给药测定麻醉平面同控制在T2～4～T8～10并在术中定时追加局麻药，分别记录麻醉前（T0）、插管后（T1）、手术开始时（T2）、手术探查时（T3）、气管拔管时（T4）的血液动力学指标，清醒、气管拔管时间及全麻药的用量。结果 GA＋EA组各项指标各时间点变化不明显（P〉0．05），而GA组则显著升高（P〈0．01）；术后清醒及气管拔管时间对照组明显长于GA＋EA组，两组比较有显著性差异（P〈0．01）。GA组全麻药的用量明显多于GA＋EA组（P〈0．01）。结论 全麻复合胸段硬膜外阻滞术中应激反应明显减轻，循环功能相对稳定，麻醉用药量减少，苏醒快，缩短苏醒、气管拔管时间，是一种安全可行的麻醉方法。．

Objective To study the influence of general anesthesia combined with epidural block on homodynamics and the revival time in patients undergoing thoracic surgery. Methods Forty patients undergoing thoracic surgery, ASA Ⅰ～Ⅱ were randomly assigned into two groups： general anesthesia group （group G） 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 T4-5 or T5-6, The anesthesia plan was under T2～4 T8～10 level. The homodynamic stander, revival time, the tracheal extubation time and the dose of anesthetic were recorded respectively before induction（T0）, after tracheal intubation（T1 ）, during skin incision（ T2）, 2h after skin incision（T3） and after tracheal extubation（T4）. Results There was no significant difference among the standers in the group GE＋EA,while they increases in the group GA. The revival time and the tracheal extubation time in group GA was longer than the group GA＋EA（ P 〈0.01）;The doses of anesthetic in group GA are greater than those in group GA＋EA （ P 〈0.01）. Conclusion General anesthesia combined with epidural block can stabilize the hemodynamics and reduce the stress. It can be applied safely and effectively.