硬膜外利多卡因加芬太尼、曲马多的麻醉效应

Anesthetic effects of epidural lidocaine with fentanyl or tramal

目的 :观察硬膜外利多卡因加芬太尼、曲马多对上腹部手术的麻醉效应。方法 :按美国麻醉学会 (ASA)五级分类法 ,6 7例Ⅰ～Ⅱ级胆道手术患者随机分为三组 :芬太尼组 (F组 )、曲马多组 (T组 )及利多卡因组 (L)组。每组硬膜外首剂量均为1.6 %利多卡因 2 0ml,F组含芬太尼 0 .1mg ,T组含曲马多 10 0mg。于首剂量麻醉期间对镇痛效应、肌松度、内脏牵拉反应予分级评定 ,同时连续监测血流动力学和血氧饱和度。结果 :三组麻醉镇痛效应相同 (P >0 .0 5 ) ,肌松以F组较差 (P <0 .0 1) ,抑制内脏牵拉反应则F组和T组效果好 (P <0 .0 1) ,且F组和T组血压下降的病例数比L组少 (P <0 .0 5 )。结论 :硬膜外腔应用曲马多强化麻醉是临床上可行的一种方法。

?Objective:To observe anesthetic effects of epidural lidocaine with fentanyl or tramal during abdominal surgery.Methods:Sixty seven patients with chronic cholecystolithiasis(ASA Ⅰ～Ⅱ) were divided at random into 3 groups.Fentanyl(F) group:Patients received 0.1 mg of fentanyl in 20 ml of 1.6% lidocaine;Tramal(T) group:100 mg tramal in 20 ml of 1.6% lidocaine;Lidocaine(L) group:20 ml of 1.6% lidocaine alone as a control.The potency of anagesia,the muscle relaxation and visceral traction reaction were graded during the time of anesthesia after the first dose.Hemodynamic and oxygen saturation were monitored continuously at the same time.Results:(1)There was no significant difference in the potency of analgesia among these 3 group( P > 0.05 ).(2)The muscle relaxation in L and T group was better than that in F group( P <0.01).(3)Visceral traction reaction were dipressed more significantly in F and T group( P <0.01).(4)The incidences of hypotension in F and T group were less than that of L group during operation( P <0.05).Conclusions:The epidural lidocaine tramal is a favourable method 8 anesthesia in clinical operation.