全麻复合硬膜外阻滞用于COPD患者手术的临床分析

Clinical analysis of general anesthesia combined with epidural block anesthesia for surgery of patients with COPD

目的比较全麻复合硬膜外阻滞麻醉与单纯全麻对慢性阻塞性肺疾病(COPD)患者手术的麻醉效果及安全性。方法将合并COPD需行胸腹部手术的24例患者随机分为复合麻醉组(GE组)及单纯全麻组(GA组),分别在手术时行全麻复合硬膜外阻滞及单纯全麻的麻醉方法,比较两组患者术后苏醒时间、拔出导管时间、术后镇痛效果(VAS评分)等麻醉指标,FVC、FEV1/FVC、FEF25%～27%肺功能测定,以及肺炎、肺不张、支气管痉挛、呼吸衰竭术后呼吸系统并发症的发生率。结果 GE组术后苏醒时间、拔出导管时间、VAS评分均少于GA组(P<0.01);术后肺功能测定优于GA组(P<0.05或P<0.01)。两组呼吸系统并发症发生率无显著差异(P>0.05)。结论全麻复合硬膜外阻滞麻醉对于COPD手术患者可提高麻醉效果,增强麻醉安全性,值得临床推广应用。

Objective To compare the anesthetic effect and security between general anesthesia combined with epidural block anesthesia and general anesthesia for patients with COPD.Methods Twenty-four patients with COPD were randomly divided into compound anesthesia group （GE group） used general anesthesia combined with epidural block anesthesia and general anesthesia group （GA group） used general anesthesia.The anesthesia indexes of recovery time,extubation time,postoperative analgesia （VAS score） , the lung function tests of FVC,FEV1/FVC%,FEF25%~27% and the postoperative respiratory complications of pneumonia, pulmonary closure, bronchiospasm and respiratory failure of the patients in both groups were compared.Results Postoperative recovery time and extubation time of the patients in GE group were shorter than those of the GA group（P0.01） . VAS scores of the patients in GE group were lower than those of the GA group（P0.01）. Postoperative lung function tests of the patients in GE group were better than those of the GA group（P0.05 or P0.01）. There was no significant difference in incidence of respiratory complications（P0.05）.Conclusion General anesthesia combined with epidural block anesthesia for patients with COPD can improve anesthetic effect,enhance anesthesia safety and is worthy of clinical application.