硬膜外阻滞复合全身麻醉在上腹部及胸内肿瘤手术应用的临床研究

Application of epidural block combined with general anesthesia in upper abdominal and thoracic tumor surgery study

目的比较硬膜外联合全身麻醉与单纯全麻在上腹部及胸内肿瘤手术中的麻醉效果。方法选择2013年7月~2014年12月期间我院收治的ASAⅠ~Ⅱ级择期手术的上腹部及胸内肿瘤患者80例,分为两组,各40例,A组实施硬膜外阻滞联合全身麻醉,B组采用全身麻醉。比较两组麻醉药物用量、麻醉恢复情况及不同时间血流动力学变化。结果 A组丙泊酚、芬太尼和顺阿曲库铵用量较B组明显减少,术毕自主呼吸恢复时间、拔管时间及完全清醒时间均较B组明显缩短,苏醒期疼痛躁动发生率较B组明显较低,两组比较差异有统计学意义（P〈0.05）。B组T2时HR明显较A组增快,T3和T4时HR、SBP、DBP均明显高于A组,两组差异有统计学意义（P〈0.05）。结论与单纯全麻比较,联合麻醉术中血流动力学稳定,能有效抑制手术应激反应,术后苏醒及拔管时间均短于单纯全麻组,围术期应用更具有安全性和平稳性。

Objective To compare the effect of epidural anesthesia combined with general anesthesia and general anesthesia in upper abdominal and thoracic tumor surgery anesthesia. Methods A total of 80 cases of ASA I - I1 elective surgery with the abdomen and chest patients were selected from July 2013 to December 2014 in our hospital, and divided into two groups, each of 40 cases, group A was treated with epidural block joint general anesthesia, group B was treated with general anesthesia. The amount of the anesthesia drug, anesthesia recovery and hemodynamie changes at different times of two groups were compared. Results Propofol, fentanyl and cis-atracurium dosage of group A were significantly reduced than group B, spontaneous breathing surgery recovery time, extubation time and fully awake time were significantly shorter, the occurrence of emergence agitation pain was significantly lower, the differences were statistically significant（P〈O.05）. HR in group B on T2 was significantly faster than group A, HR, SBP, DBP on T3 and T4 were significantly higher than that in group A, the differences were statistically significant （P〈 0.05）. Conclusion Compare with general anesthesia, anesthesia of intraoperative hemodynamic stability, can suppress the stress response to surgery, recovery after extubation time is shorter than the general anesthesia group, perioperative application is more security and stability.