哮喘患者麻醉方案的可行性研究

Feasibility study of anesthesia program for asthma patients

目的探讨哮喘病患者硬膜外麻醉联合无阿片类镇痛药全身麻醉能否有效预防术中哮喘的发作。方法选取年龄30~60岁、美国麻醉医师协会分级Ⅱ、Ⅲ级并有支气管哮喘的肺部病变患者50例,随机分为采用常规气管插管的对照组和采用硬膜外麻醉联合无阿片类镇痛药全身麻醉的实验组。麻醉后采集患者麻醉前(T_0)、诱导后插管前(T_1)、气管插管即刻(T_2)、插管后5 min(T_3)、清醒准备拔管时(T_4)及拔管后5 min(T_5)各时点的生命体征,进行统计学分析。结果两组患者在不同时点的Sp O_2、BIS比较有差异(P<0.05);两组患者Ppeak比较有差异(P<0.05),实验组Ppeak比对照组低,两组的Ppeak变化趋势有差异(P<0.05)。对照组术中哮喘发作、清醒后耐受气管导管及清醒后切口疼痛患者较实验组多(P<0.05)。两组患者术后挣扎躁动、术中知晓人数及术后咽喉部疼痛不适等指标比较无差异(P>0.05)。结论硬膜外麻醉联合无阿片类镇痛药全身麻醉能获得较好的麻醉效果,可降低术中哮喘的发生率,并能安全地应用于哮喘患者。

Objective To study whether epidural anesthesia combined with general anesthesia without an opioid analgesic in patients with history of asthma could effectively prevent an asthma attack during operation.Methods Fifty patients（ASAII-III）,aged 30-60 y,with the history of bronchial asthma and pulmonary lesions,were randomly divided into group I（routine tracheal intubation group,n=25）and group II（epidural anesthesia combined with general anesthesia without an opioid analgesic group,n=25）.The MAP,HR,BIS,Sp O2,Ppeak and PETCO2were recorded before anesthesia（T0）,before intubation after anesthesia induction（T1）,at the moment of trachea intubation（T2）,5 min after intubation（T3）,resuscitation before extubation（T4）,and 5 min after extubation（T5）.Other indexes were recorded too,including the number of intraoperative asthma cases,endotracheal tube tolerance after sober,incision pain after sober,agitation and struggle after operation,intraoperative awareness,throat pain and discomfort after surgery and so on.Results At various time points,the Sp O2 and BIS values of the two groups were different（P〈0.05）;the Ppeak in the group II was significantly lower than that in the group I（P〈0.05）and there was a significant difference in the variation trend of the Ppeak between the two gruops（P〈0.05）.Meanwhile,the incidences of asthma attack,endotracheal tube tolerance after sober and incision pain after sober in the group I were significantly higher than those in the group II（P〈0.05）.There was no significant difference in agitation and struggle after operation,intraoperative awareness,or throat pain and discomfort after operation between the two groups（P〈0.05）.Conclusions Epidural anesthesia combined with general anesthesia without an opioid analgesic can be safely used in patients with the history of asthma,and can effectively reduce the possibility of intraoperative asthma attack,which is worth further study in clinical anesthesia.