一项前瞻性随机双盲研究：胸段硬膜外给予新斯的明对腹主动脉手术后肠梗阻的影响

背景手术后肠梗阻是腹主动脉手术主要的胃肠并发症，可增加患者发病率和死亡率，延长住院时间，增加医疗费用。本项研究中，我们评价了硬膜外给予新斯的明对腹主动脉手术术后肠梗阻的影响。方法选择我院45例行择期腹主动脉手术的患者。所有患者均接受相同的全麻联合硬膜外麻醉。全麻诱导前，于T7～T8间隙放置硬膜外导管，给予布比卡因20ml（Q5％）（推注时间〉15分钟）。将患者随机分成两组，术毕和术后8小时分别通过硬膜外导管给予生理盐水稀释的1μg／kg新斯的明5ml（Ⅰ组），或给予生理盐水5ml（Ⅱ组）。在重症监护病房记录手术后出现肠鸣音的时间，同时记录每天肛门排气与排便的时间。结果Ⅰ组患者第1次出现肠鸣音时间和肛门排气时间均明显短于Ⅱ组（分别为11．6±11．2小时vs 22．6±12．8小时；21．8±15．6小时vs 36．6±19．1小时，P〈0．05）。两组第1次排便时间相近（P〉0．05）。Ⅱ组手术后恶心的发生明显高于Ⅰ组（P〈0.05）。两组手术后并发症发生率相近（P〉0.05）。结论胸段硬膜外给予新斯的明能够使腹主动脉手术后肠鸣音恢复更快，手术后肠梗阻时间缩短。

BACKGROUND： Postoperative ileus is a major gastrointestinal complication of abdominal aortic surgery leading to increased rates of morbidity and mortality, longer lengths of hospital stay, and higher costs. In this study, we evaluated the effect of epidurally administered neostigmine on postoperative ileus after abdominal aortic surgery. METHODS： We enrolled 45 patients who were scheduled for elective abdominal aortic surgery at our institution. All patients received identical general and epidural anesthesia. Before the induction of general anesthesia, an epidural catheter was placed at the T7 - T8 intervertebral space, and 20 ml bupivacaine （0. 5% ） was injected over 15 min. Patients were randomized into two groups. Patients received a 5 ml bolus of neostigmine （1 μg/kg） diluted with normal saline （Group 1 ） or a 5 ml bolus of normal saline （Group 2） via an epidural catheter at the end of surgery and 8 h postoperatively. Times of bowel sounds were recorded post- operatively in the intensive care unit. Times of daily passage of flatus and defecation also were recorded. RESULTS： Times to the first bowel sounds and the first flatus were significantly shorter in Group 1 than they were in Group 2 （11.6 ± 11.2 h vs 22.6 ± 12.8 h and 21.8 ± 15.6 h vs 36.6 ± 19. 1 h, respectively, P 〈 0.05）. The times to first defecation were similar in both groups （P 〉 0. 05）. Nausea was more frequent in patients in Group 2 than in Group 1 （P 〈 0, 05）. The incidence of posto- perative complications was similar between the groups （P 〉 0.05 ）. CONCLUSIONS： Thoracic epidural neostigmine enables faster restoration of bowel sounds and shortens duration of postoperative ileus after abdominal aortic surgery.