全麻复合硬膜外阻滞围拔管期的心血管反应

Cardiovascular reactions to general anesthesia combined with epidural block surrounding extubation

目的观察全身麻醉复合硬膜外阻滞对围拔管期心血管的反应。方法对40例气管插管全麻下手术患者，随机分成复合组与对照组，每组20例，两组麻醉前用药、麻醉诱导和维持方法相同，分别观察记录两组术前、拔管前5min、吸痰拔管时，拔管后5min的心率（HR）、收缩压（SBP）、舒张压（DBP）。结果对照组围拔管期心血管反应强烈，在吸痰拔管时、拔管后5min的HR、SBP、DBP明显高于拔管前5min和复合组，以吸痰拔管时最为明显。复合组仅在吸痰拔管时HR、SBP升高，拔管后5min基本恢复，DBP变化不明显。结论全麻复合硬膜外阻滞对围拔管期心血管反应或心脑血管意外等并发症的发生有一定的预防作用，对原有高血压、冠心痛患者尤为有益。

Objective To observe the cardiovascular reactions to general anesthesia combined with epidural block surrounding extubation. Methods Forty patients were divided into the general anesthesia plus epidural block group（ group Ⅰ ） and general anesthesia group （ group Ⅱ ） randomly. Each group had 20 patients. The two groups were given the same preanesthetic medication,anesthesia induction and maintenance. HR,SBP and DBP of two groups before operation,5 minutes before extubation,during extubation and 5 minutes after extubation were monitored and recorded respectively. Results The cardiovascular reactions were more intensive in group Ⅱ which had higher HR, SBP and DBP during extubation and 5 minutes after extubation than 5 minutes before extubation and than group Ⅰ. HR and SBP in group Ⅰrised only during extubation and recovered 5 minutes after extubation and DBP had no significant change. Conclusion General anesthesia combined with epidural block had certain prophylaxis effects on the complications such as cardiovascular reaction and cardiocerebrovascular accident surrounding extubation. It was much more helpful to patients with hypertension or coronary artery disease.