异丙酚全麻与全麻联合硬膜外阻滞行大肠手术的比较

Performing Large Intestinal Operation under Propofol General Anesthesia and General Anesthesia Combined with Epidural Block.A Comparative Study

研究相同剂量异丙酚全麻与全麻联合硬膜外阻滞行大肠手术对循环、血糖及术后苏醒的影响。ASAⅠ-Ⅱ级择期行结、直肠手术的病人44例，随机分为G1组（持续异丙酚静脉泵入复合微量泵持续硬膜外泵入组）和G2组（单纯异丙酚静脉泵入复合吸入麻醉组），每组22例。观察两组病人在插管后、切皮、术中及拔管后血糖变化，并记录术毕停药后自主呼吸恢复时间，呼之睁眼时间，拔管时间，定向力恢复时间。结果显示，G1组于插管后、切皮时、术中及拔管即刻时间段平均动脉压，心率变化较G2组略低且平稳（P〈0.05），G1组麻醉前后血糖无明显改变，但G2组较G1组插管后、切皮时、拔管即刻显著升高（P〈0.05）。G1组术毕定向力恢复时间及出手术窀时间早于G2组。结果表明，相同剂量异丙酚静脉持续泵注复合微量泵持续硬膜外推注局麻药可以在围术期完善镇痛、镇静、肌松效果，提高患者术后恢复质量，全麻联合硬膜外麻醉可以在稳定血流动力学的同时，更好的满足手术要求，提高术后恢复质量。

The aim of this study was to investigate and compare the influences on circulation,blood glucose and post-operation resurgence of patients subjected large intestine operation by propofol general anesthesia and by general anesthesia combined with the epidural block with the same dosage propofol. The 44 cases of （ASA Ⅰ-Ⅱ degree） selective rectum operations,were divided at radom into group G, and group G2,22 cases in each group; G1 ：sustaining propofol injection into vein combining sustaining epidural injection by micro pump;G2 ：pure propofol injection into vein combining inhalational anesthesia. Among the 44 cases the blood glucose changes of the two groups were observed after cannula,during skin incision and operation as well as after tube drawing;and the time for spontaneous respiration recovery, eye opening, tube drawing and recovery of orientation force after operation were recorded. As results, during the instant time section of post-cannula, skin incision,operation and tube drawing, the changes of average artery pressure and heart rate of group G1 was a little lower and steady than group G2 （ P〈0.05） ;the blood glucose of group G1 had no notable changes before and after anesthesia, but that of group G2 increased notably and instantly after cannula,at skin incision and tube drawing compared with group G1 （ P 〈0.05）. The differences between the two groups in spontaneous respiration recovery time, eye opening time and tube drawing time had no significance;however,time for recovering orientation force and exiting operation room of patients in group G1 was earlier than that of group G2. These results show that the sustaining injection of the same dosage propofol into vein combining sustaining epidural injection in peri-operative period can offer perfect composure muscularorelaxaion and improve the recovery quality of patients after operation and ease their pains after operation;adopt the micro pump injection method and general anesthesia combined with epidural anesthesia can better meet the operation requirement at the same time of stabilizing the hemodynamics and improve the recovery quality after operation.