硬膜外阻滞复合瑞芬太尼、丙泊酚静脉全麻在上腹部手术中的应用

Effects of Combination of Remifentanil and Propofol Epidural Anesthesia in Upper Abdominal Surgery

【目的】探讨硬膜外阻滞复合瑞芬太尼、丙泊酚静脉全麻在上腹部手术中的可行性和应用效果。【方法】48例择期胃癌手术患者,随机分为静吸复合全麻(G组,n=20)和硬膜外复合静脉全麻组(E组,n=24)。记录并比较两组各时点平均动脉压(MAP)和心率(HR)和术后恢复情况如自主呼吸恢复时间,轻唤睁眼时间,拔管时间。【结果】两组病人麻醉诱导后MAP均有不同程度下降,与诱导前相比有统计学意义(P<0.01)。在探查与拔管后即刻,G组MAP均明显上升,与基础值相比差异显著(P<0.01)。而E组MAP变化不大,组间比较差异显著(P<0.01)。HR在麻醉诱导后较前下降,以E组明显,组间比较差异显著(P<0.05),在探查时,G组HR较基础值增快,组间比较差异显著(P<0.05)。术后自主呼吸时间,轻唤睁眼时间,拔管时间,E组明显短于G组,两组相比差异显著(P<0.01),拔管后5minOAA/S评分E组高于G组(P<0.05),拔管后10min语言评价量表(VRS)评分,E组均完全不痛,两组相比差异显著(P<0.01)。【结论】硬膜外复合瑞芬太尼、丙泊酚静脉全麻能满足上腹部手术要求。

[Objective] To evaluate the sedative effects of remifentanil combined with propofol during epidural anesthesia in upper abdominal surgery. [Methods] Forty eight patients with ASA class Ⅰ or Ⅱ elected for gastrectomy were assigned into two groups with 24 cases each. The patients in group G and group E were given isoflurane and propofol anesthesia and combined epidural and intravenous anesthesia with remifentanil respectively. The changes of MAP, HR, the time of spontaneous respiration, awakening time, extubation time, the OAA/S score 5 min after extubation and the VRS score 10 minutes after extubation were recorded. [Resuits] The decrease of MAP, HR at exploration and after extubation in group E was significant different from that in group G. And the time of spontaneous respiration, awakening time and extubation time in group E were shorter than those in group G （ P 〈0. 05）. The OAA/S score 5 minutes after extubation and the VRS score 10 minutes after extubation in group E were higher than those in group G. [Conclusion] Remifentanil combined with propofol during epidural anesthesia is beneficial for hemodynamic changes and analepsia quality in upper abdominal surgery.