气管内联合硬膜外麻醉用于上腹部手术的超前镇痛

Preemptive Analgesia Of Endotracheal Anesthesia Combined With Epidural Anesthesia During The Operation On Upper Abdominal Region

研究气管内联合硬膜外麻醉应用于上腹部手术中，硬膜外用药的时间不同、全麻诱导及维持的药物不同对术后镇痛的影响。方法将120例上腹部手术患者随机分为A、B、C三组，每组40例。A组：术前经T8-9硬膜外腔注入2％利多卡因和0．25％丁卡因混合液8ml，再经硬膜外腔注入曲马多1mg／kg，全麻诱导药物为芬太尼4μg／kg，丙泊酚1—2mg／kg，咪唑安定0．02—0．04mg／kg，维库溴胺0．1mg／kg。B组：全麻诱导及维持药物中均不使用芬太尼，用利多卡因1mg／kg代替，其余同A组。C组：在T8-9间硬膜外穿刺成功后行全身麻醉，诱导及维持药物同A组，切皮后90min，经硬膜外注入2％利多卡因和0．25％丁卡因混合液8ml，再经硬膜外腔注入曲马多1mg／kg。分别观察各组切皮前后血流动力学变化，于术毕4、8、24、48h观察VAS评分、镇痛药的用量以及术后恶心、呕吐、烦躁不安、皮肤瘙痒等指标。结果A组术后镇痛药用量最少，镇痛效果最好；B组和C组在VAS评分、镇痛药的用量及毒副作用方面无明显区别。结论气管内联合硬膜外麻醉用于上腹部手术时，硬膜外麻醉与芬太尼同时使用术后镇痛效果最好。

Objective To investigate the effect of postoperative analgesia with differential time of epidural medication, differential derivation and maintained medicine of general anesthesia, during the operation on upper abdominal region with endotracheal anesthesia combined with epidural anesthesia. Method 120 cases were seperated to three groups（ A, B, C）in random, each group had 40 cases. Group A： influx mixed liquor of 2% Lidocaine and 0. 25% Tetracaine 8 ml to cavitas epiduralis through Ts_9 ;after that influx Tramadol to cavitas epiduralis, 1 mg/kg; revulsive of general anesthesia was Fentanyl 4μg/kg, Propofol 1-2 mg/kg, Midazolam 0.02-0. 04 mg/kg, Vecuronium Bromide O. 1 mg/kg. Group B ： during the derivation and maintain of general anesthesia, Fentanyl was not used, replaced by Lidocaine 1 mg/kg, others were same to group A. Group C ： after epidural puncturation through T8-9 , then start the general anesthesia, samed to group A, slivered skin ,90 min later, influx mixed liquor of 2% Lidocaine and 0. 25% Tetracaine 8 ml to cavitas epiduralis through T8-9 ;after that influx Tramadol to cavitas epiduralis, 1 mg/kg;to observe the difference of the hemodynamics before and after the skin slivered seperatedly, to observe indexes included VAS score, the dosis of pain-killer and postoperative nausea, emesis, dysphoria, itch of skin etal,4,8,24,48 hours after the operation. Result Group A ： the dosis of pain-killer was least, the effect of analgesia was best. Group B and C had not obviouse difference in VAS score,the dosis of pain-killer and secondary action. Conclusion during the operation on upper abdominal region with endotracheal anesthesia combined with epidural anesthesia, epidural anesthesia and Fentanyl were used at the same time, the effect of postoperative analgesia was best.