硬膜外麻醉上腹部手术围手术期膈肌功能研究

Study of Perioperative Diaphragmatic Function in Upper Abdominal Surgery under Epidural Anesthesia

目的 :观察硬膜外麻醉上腹部手术 (UAS)病人围手术期膈肌功能变化。方法 :在连续硬膜外麻醉下行上腹部手术病人 12例 ,麻醉前置入胃管 ,同步监测胃内压 (Pga)与呼出气CO2 分压曲线 ,记录术前、术后 1、4、8小时平静呼吸时胃内压变化 (ΔPga)、RR、VT。吸气时Pga降低 (记为ΔPga =- 1)为腹部反常呼吸运动 ,吸气时Pga上升 (记为ΔPga =+1)。结果 :所有病人术前ΔPga均为 +1,于术后 1小时出现ΔPga =- 1(P <0 0 0 1) ,并且持续至术后 8小时。RR加快 (从术前 15 2± 2 1至术后 1、4、8小时分别为 2 0 2± 2 5、2 2 6± 2 8、2 1 8± 2 2P <0 0 0 1)、VT 减少 (由术前2 98± 16ml/m2 至术后 1、4、8小时分别为 2 2 5± 2 7、197± 2 5、2 19± 2 2ml/m2 P <0 0 0 1)。结论 :与全麻下UAS类似 。

Objective: The current study asseeses perioperative diaphragmtic function during upper abdominal surgery (UAS) under epidural anesthesia. Methods: Twelve patients undergoing UAS under thoracic epidural anesthesia were included. Gastric tube was placed before epidural catheterization. Tidal changes in gastric pressure (ΔPga), V T and RR were measured before anesthesia, at 1h,4h and 8h after surgery. Negative change in ΔPga (ΔPga=-1) was observed as an indicator of abdominal paradoxical movement. Results: A negative change in ΔPga appeared at 1h after surgery(P<0 001) associated with an increase in respiratory rate(from 15 2±2 1 at 20 2±2 5、22 6±2 8、21 8±2 2 P<0 001 to 1、4、8h after surgery ) and a decrease in V T (from298±16ml/m 2 to 1、4、8h after surgery 225±27、197±25、219±22ml/m 2 P<0 001), while MV remained unchanged. Conclusion: UAS under epidural anesthesia induces diaphragmatic dysfunction resembling that of general anesthesia.