比较全麻与全麻复合硬膜外阻滞对拔管期呼末七氟醚浓度及血流动力学的影响
时间：2010-08-24 10:19:10 来源： 作者：
| 方法：选择ASAI－II级的行上腹部手术病人30例，年龄25—55岁，随机分成两组，单纯吸入全麻组（A）与全麻复合硬膜外阻滞组（B），每组15人。硬膜外复合吸入全麻组诱导前于T9－10间隙行硬膜外穿刺，向头侧置入硬膜外导管3cm，在给予实验量后，注入2％利多卡因10ml并测平面，术中每45分钟追加2％利多卡因5ml。两组病人全麻诱导均采用咪达唑仑0.02mg/kg, 舒芬太尼0.1ug/kg, 异丙酚1mg/kg, 罗库溴胺0. 6mg/kg完成气管内插管。术中追加罗库溴胺0.３mg/kg。全麻诱导后行机械通气，氧流量 为2L／min，潮气量8-10ml/kg, 手术开始前七氟醚的吸入浓度为1.0MAC, 手术开始后调整七氟醚的吸入浓度为3.0MAC，调整呼吸频率维持呼末二氧化碳35mmHg左右, 缝皮结束时停止七氟醚的吸入。分别于术中，睁眼，拔管时记录MAP, HR, SPO2,呼末七氟醚浓度及病人睁眼时间（停止吸入麻醉药到睁眼的时间），拔管时间（停止吸入麻醉药到拔管的时间），醒后有无呛咳，躁动。 结果：与A组（单纯全麻组）相比， B组（全麻复合硬膜外阻滞组）病人睁眼，拔管时的MAP, HR均低于A组（p<0.05）。B组病人睁眼时间、拔管时间均长于A组(p<0.05)，同样与A组相比，B组病人睁眼、拔管时呼末七氟醚浓度则均低于A组（p<0.05），而VAS评分亦低于A组（p<0.05），两组病人均未发生苏醒期呛咳、喉痉挛、呼吸抑制等不良反应。 结论: 椎管内麻醉复合全麻可以有效地加强麻醉效果，但应相应减少术中吸入麻醉药的用量，这样拔管时在保证病人的无痛，安全和舒适的同时不会使苏醒时间延迟，也可以预防术中低血压的发生。 关键词：七氟醚； 全麻； 全麻复合硬膜外阻滞 Comparison of general anesthesia and general anesthesia combined with epidural block in end-tidal sevoflurane concentration and hemodynamic responses during tracheal extubation Juan Liu Chen Zhang Yun Yue Qing Zhang Department of Anesthesiology, Beijing Chao Yang Hospital , Capital Medical University ABSTRACT Objective： To compare general anesthesia and general anesthesia combined with epidural block in end-tidal sevoflurance concentration and hemodynamic response during eye-opening and extubation . Methods： Thirty patients ASA grade I－II (18 male, 12 female) aged 25-55 years for upper abdominal surgery were randomly divided into general anesthesized group (n=15)（A）and general anesthesized combined with epidural block group (n=15)（B）.In B group (general anesthesizedcombined with epidural block group) epidural anesthesia was performed at T9-10 before induction of general anesthesia. Acatheter was inserted into the epidural space in acephalad direction for 3cm. A loading does of 10ml of 2% lidocaine was given after test dose followed by 5ml 2% lidocanine every 45min. In both groups general anesthesia were induced with midazolam 0.02mg/kg, sufentanyl 0.1ug/kg, propofol 1mg/kg, esmeron 0.6mg/kg and intermittent bolus of esmeron. .The patients were intubated and mechanically ventilated . PCO2 was maintained 35-40 mmHg. Fresh gas flow (FGF) was set at 2L/min after induction and maintained for 30 min, then reduced to 1L/min. Sevoflurane was set at 1.0 MAC after induction and the inspired concentration was adjusted to 3.0 MAC. At the end of surgery the inhalational anesthetic was discontinued. If blood pressure less than 60mmHg were given intravenous injection ephrine. The end-tidal sevoflurane concentration and hemodynamic variables such as MAP, HR, SPO2, were recorded immediately before induction (T1) ， 30min after operation (T2) , eye-opening (T3), exhalation (T4). The time from the discontinuation of inhalational anesthetic to eye-opening, exhalation were measured . Results: There were no significant differences between the two group with respect to age, sex, body weight, duration of operation and types of surgery（p>0.05）. MAP and HR were significantly reduced in group B（p<0.05）during intraoperation, and eye-opening, extubation . The end-tidal sevoflurence concentration of exhalation in group B less than A during eye-opening and extubation , as well as VAS（p<0.05）. The time from the discontinuation of inhalational anesthetic to eye-opening, exhalation in group A (general anesthesized patients ) shorter than those in group B (general-epidural anesthesized patients) （p<0.05）. Conclusion: General anesthesia combined with epidural block can be more effectively and safely applied but would reduce anesthetic dosage to prevent from hypotention in intraoperation. It is not only guarantee painless and comfortable to patients but also not delay eye-opening and exhalation time. Key words: sevoflurance； general anesthesized ； general anesthesia combined with epidural block 七氟醚做为新型卤类吸入麻醉药，由于其低血-气和血-组织溶解性使其具有诱导苏醒迅速平稳、对呼吸循环影响小、麻醉可控性强等优点［1，2］而已被越来越多的麻醉医生接受。本研究拟采用单纯吸入七氟醚全麻和硬膜外复合吸入七氟醚全麻这两种麻醉方法，比较术后拔管时两组病人的呼末七氟醚浓度，血流动力学的变化，睁眼时间，拔管时间，拔管期VAS评分以及有无躁动，呛咳，屏气等不良反应的发生。使病人在适宜的麻醉状态下拔管，既能保持呼吸道的防御反射又能减轻拔管时所产生一系列的不良反应，从而为临床麻醉提供参考。 一﹑资料和方法
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