梗阻性黄疸手术应用单纯全麻与全麻复合硬膜外阻滞疗效比较

Comparison of General Anesthesia with Combined General-epidural Anesthesia in Surgery of Obstructive Jaundice

目的比较单纯全麻和全麻复合硬膜外阻滞在梗阻性黄疸手术中对患者血液动力学变化及术后苏醒的影响。方法选择40例梗阻性黄疸患者,随机分成单纯全麻组(全麻组)、全麻复合硬膜外阻滞组(复合组),每组20例。两组全麻方法相同,复合组在全麻基础上是复合低浓度小剂量硬膜外阻滞。记录入室后、插管时、术中、拔管时的HR、MAP,两组病人麻醉维持用药量及清醒拔管时间,术后躁动情况。结果复合组在插管拔管过程中HR、MAP均较全麻组低且平稳(P<0.05),全麻组拔管反应剧烈,在插管、拔管时各项指标与诱导前比较均显著升高(P<0.05)。全麻组全麻用药芬太尼、异氟醚、维库溴铵等用药量均显著多于复合组(P<0.05)。复合组较全麻组清醒快,拔管时间明显早于全麻组(P<0.05)。复合组发生躁动1例,显著低于全麻组的11例,P<0.05)。结论全麻复合硬膜外阻滞更加适合于梗阻性黄疸病人的麻醉。

Objective To compare the influence of hemodynamic variation and conscious recovery in general anesthesia with combined general-epidural anesthesia in operative patients with obstructive jaundice. Methods 40 cases of patients with obstructive jaundice were randomly divided into general anesthesia group （ group G） and combined general-epidural anesthesia group （ group G ＋ E） , with 20 for each. General anesthesia was induced with midazolam O. 1 rag/ kg, Fentanyl 2 μg/kg, vecuronium 0. 1 - 0. 15 mg/kg and propofol 1 - 2 mg/kg in both groups. Plus low dose and concentration epidural blocking agent was administration in group G ＋ E. HR and MAP of entering, during intubation, during operation and extubation, dosage of anesthetics, awakening time and dysphoria were recorded. Results HR and MAP were stabler in group E ＋ G than those of group G （ P 〈 0. 05 ）. In group G the hemodynamic changes were violenter at intubation and extubation than that of pre-anesthesia（ P 〈 0. 05）. The dosage of anesthesia and awakening time in group E ＋ G were less than those in group G（ P 〈0. 05 ）. Eleven cases suffered dysphoria in group G, which were more than one case in group E ＋ G （ P 〈 0. 05 ）. Conclusion Combined general-epidural anesthesia could be more suitable in operative patients with obstructive jaundice with stable hemodymamic changes, low anesthetics dosage and shorter awakening time.