腹部手术中硬-全联合麻醉对血流动力学及牵拉反应的影响

General Anesthesia Combined with Epidural Anesthesia Effect on Hemodynamics and Drag Reactions in Abdominal Operation

目的探讨腹部手术中硬-全联合麻醉对血流动力学及内脏牵拉反应的影响。方法将上海市中西医结合医院2009年1月至2012年8月收治的行腹部手术的270例患者按麻醉方式分为三组:连续硬膜外麻醉组(A组)、全麻组(B组)、硬-全联合麻醉组(C组),各90例。比较三组入室切皮(T1)、探查(T2)、牵拉(T3)、术毕(T4)的收缩压、舒张压、心率及牵拉反应等发生情况。结果A组的收缩压、舒张压及心率出现较大波动,A组的收缩压、舒张压及心率T3与T1时刻比较差异有统计学意义(P<0.05);B组、C组在T3时的收缩压、舒张压及心率均显著低于A组(P<0.05);A组的牵拉反应显著高于B组和C组(P<0.05)。结论硬-全联合麻醉导致牵拉反应小,血流动力学影响小,可控性好,用于腹部手术麻醉更具有优势。

Objective To explore the effect of general anesthesia combined with epidural anesthesia on hemodynamics and drag reactions in abdominal operation. Methods From Jan. 2009 to Aug. 2012,270 cases of abdominal operation admitted to ShangHai TCM Western Medicine [ntergrated Hospital were divided into three groups ： continuous epidural anesthesia group （ group A ） , general anesthesia group （ group B ）, general anesthesia combined with epidural anesthesia group （group C ）. The systolic blood pressure （SBP）, diastolic blood pressure（DBP） ,heart rate（HR） and drag reaction were compared respectively at the time of cut skin （ Tl ） , searching（ T2 ） , dragging（ T3 ） , operation over （ T4 ）. Results SBP, DBP, HR and drag reac- tion in group A showed up comparatively large fluctuation, SBP, DBP and HR at T3 were much higher than at Tt （ P 〈 0.05 ）. At T3 , SBP, DBP and HR in group B and C were much lower than group A （ P 〈 0.05 ）. And drag reaction in group A was much higher than group B and C （P 〈 0.05 ）. Conclusion General anesthesia combined with epidural anesthesia shows lower internal organs drag reactions, stable haemodynamics and good controllability, which is safe to be used in abdominal operation.