全麻复合胸段硬膜外阻滞对重症肌无力患者血流动力学的影响

Effects of combination of general anesthesia and thoracic epidural blockade on hemodynamic in patients with myasthenia gravis undergoing thymectomy

目的探讨全麻复合胸段硬膜外阻滞对重症肌无力患者围术期血流动力学以及拔管时间的影响。方法将42例择期行胸腺扩大切除术的重症肌无力患者（ossetmannⅠ-Ⅱb型）随机分为全麻复合硬膜外组（GEA组，n=20）和单纯全麻组（GA组，n=22）。监测两组患者在麻醉前（T1）、插管时（T2）、切皮时（T3）、劈胸骨时（T4）及拔管时（T5）的平均动脉压（MAP）和心率（HR）的变化以及两组患者单位时间内全麻药的用量；并同时记录两组患者术毕至拔管、完全清醒时时间。结果两组患者在T2、T3、T4、T5与T1比较，MAP和HR均升高；GA组患者MAP和HR升高的幅度明显高于GEA组患者（P〈0．05）；GA组全麻药用量明显高于GEA组（P〈0．01）；GEA组术毕拔管和清醒时间明显短于GA组（P〈0．01）。结论全麻复合胸段硬膜外阻滞能够保证重症肌无力患者围术期血流动力学的稳定，减少全麻药的用量，缩短拔管时间，是目前可行且较为理想的麻醉方法。

Objective To discuss the effects of combined general anesthesia and thoracic epidural blockade on hemodynamic and extubated time in the patients with myasthenia gravis undergoing thymectomy. Methods Forty-two patients suffering from myasthenia gravis（ossermann Ⅰ-Ⅱb） undergoing expand thymeetomy were randomly divided into general anesthesia combined with epidural anesthesia group （GEA group, n=20） and general anesthesia group（GA group,n= 22）. The changes of MAP and HR were monitored before induction of anesthesia （ T1 ）, intubation （ T2 ）, during skin incision （ T3 ）, sawed sternum （ T4 ）, extubation （T5） ,the dosage of general anesthetics and each index＇s time after operation to awake were recorded in two-group patients. Results The MAP and HR in two-group patients with T2,T3,T4,T5 compared with T1 heightened obviously,the MAP and HR in the patients of GA group were obviously higher than those in GEA group at the same time（P〈0.05）. The general anesthetics dosage in the patients of GA group was remarkably more than those in GEA group（P〈0.01）. The extubation time and awake time after operation in the patients of GEA group were less than those in GA group（P〈0.01）. Conclusion General anesthesia combined with thoracic epidural blockade could ensure the stability of haemodynamic in myasthenia gravis patients undergoing thymectomy,reduce the dosage of general anesthetics and shorten the time of extubation.