全麻复合硬膜外阻滞不同给药方式用于上腹部手术的临床观察

Combination of general anesthesia with epidural block in the different ways of administration on upper abdominal operation

目的：比较全麻复合硬膜外阻滞麻醉中局麻药硬膜外分次推注与硬膜外负荷剂量加微量泵持续注入的麻醉效果与安全性。方法：选择上腹部手术患者40例，随机分A、B组，每组20例。2组硬膜外穿刺确定在硬膜外腔后全麻诱导，麻醉机控制呼吸，A组硬膜外注入0．5％左旋布比卡因4～8ml，术中每2小时追加3～6ml；B组0.5％左旋布比卡因负荷剂量3～5ml后用微量泵以2～4ml／h持续注入至术毕。术中连续监测心电图（ECG）、心率（HR）、血氧饱和度（SPO2）、收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）。结果：A组与B组比较，硬膜外用药5min时SBP、DBP、MAP差异有统计学意义（P〈0．05），A组硬膜外用药5min时与麻醉前比较SBP、DBP、MAP差异有统计学意义（P〈0．05）。结论：全麻复合硬膜外阻滞麻醉中，采用硬膜外微量泵恒速注药对病人生理干扰小，麻醉效果好，血流动力学平稳。

Objective： To compare the effects and safety of the interval epidural infusion with those of the continuous one using micropump after initial loading dosage in the combination of general anesthesia with epidural block. Methods. The forty cases on upper abdominal operation were randomized into two groups （A and B） each of which contained twenty. The groups were simultaneously given general anesthesia induction and respiration controlled by anesthetic machine after epidural pin was ascertained in the cavitas epiduralis. The L-bupivacaine （0.5%, 4-8 ml） was infused initially before it （0.5%, 3-6 mD was administrated in interval of every two hours during the operations in the group A. The loading dosage （0. 5%, 3-5 ml） of L-bupivacaine was infused initially before it （0.5%, 2-4 ml/h） was given continuously with micropump in the group B until operation was finished. The contihuous monitoring was carried out for ECG, HR, SPO2, SBP, DBP and MAP during operation. Results. Compared group A with B at 5 minutes in the epidural infusion, there were the statistical significancs in the SBP, DBP and MAP （P 〈0.05）. Compared at 5 minutes in the epidural infusion with before combined anesthesia in the group A, there were the statistical significancs in the SBP, DBP and MAP （P 〈0.05）. Conclusion. It suggested that continuous epidural infusion by micropump could make physiological function less affected, anesthesia effect satisfactory and haemodynamics steady for patients in the combination of general anesthesia with epidural block.