两种麻醉方法在肝叶切除术中的效能比较
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摘要
目的:探讨气管插管静脉麻醉与气管插管静脉复合硬膜外麻醉2种方法在肝叶切除术的麻醉效能。方法:择期肝叶切除术患者58例,随机分为2组:气管插管静脉麻醉组(组Ⅰ)29例直接全麻诱导;气管插管静脉复合硬膜外麻醉组(组Ⅱ)29例先行硬膜外穿刺,给予2%利多卡因ml,确定效果后,行麻醉诱导,2组诱导均选用咪达唑仑、芬太尼、维库溴胺,术中维持采用丙泊酚,间断给予维库溴胺。比较2组丙泊酚、维库溴胺、芬太尼、罗哌卡因的用药总量及手术时间,停止给予丙泊酚到患者清醒拔管的时间及有无术中知晓,术后清醒时切口是否疼痛。结果:2组患者均无术中知晓,清醒时切口均无疼痛。与气管插管静脉麻醉组相比,气管插管静脉复合硬膜外麻醉组清醒拔管时间明显缩短(P＜0.05),芬太尼、维库溴胺、丙泊酚的用药总量及药品价格均明显降低(P＜0.05)。结论:气管插管静脉复合硬膜外麻醉用于肝叶切除术,可以明显减少静脉麻醉剂芬太尼、丙泊酚及肌松剂维库溴胺的用量,并且术中血压、心率稳定,易于管理,术后苏醒拔管迅速,节约费用。
Objective:To compare the effects of two anesthetic techniques in major hepatic by the amounts of intravenous anesthetic agents and vecutonium,heart(HR),mean arterial pressure(MAP)and the time of stopping propofol to extubation.Methods: Fifty-eight patients who were undergoing elective major liver resection were randomly divided into two groups:intubation total intravenous anesthesia group(groupⅠ)and combined general-epidural anesthesia group(groupⅡ).In combined general-epidural anesthesia group epidural puncture was performed at T_(8-9)or T_(9-10).After catheter was fixed,2%lidocaine 4ml were infused into epidural,when the epidural anesthesia was working the general anesthesia was induced.In both groups,anesthesia was induced with midazolam,vecuronium,fentanyl and maintained with propofol.Vecuronium was given when necessary.In combined general-epidural anesthesia group,before skin incision 1% ropivacaine(50mg)was given through epidural catheter and the same dosage was given in every 2 hours.The total volumes of ropivacaine were recorded.In the groups, electrocardiogram,non-invasively arterial pressure,arterial oxygen saturation,airway pressure and urine production were monitored continuously.Fentanyl and vecuronium were stopped 30 minute before the end of operation.Propofol was stop when closing peritoneum.Total volumes of propofol,fentanyl,vecuronium and operation's times, times of stopping -propofol to extubation and whether having awareness at interoperation,whether having pain were all recored in both groups.Results:In both groups none of patient has awareness and pain.The amounts of fentanyl,vecuronium, propofol and the cost in total intravenous anesthesia group were significantly higher than combined general-epidural anesthesia group(P＜0.05),the time of stopping-propofol to extubation is also longer than it(P＜0.05).In the combined general-epidural anesthesia group,the change of MAP during operation is insignigicant compare to baseline,but it increase significantly in the total intravenous anesthesia.Conclusions:Combined general-epidural anesthesia in hepatectomy can decrease the amount of fentanyl, vecuronium and propofol and more stability of hemodynamic,earlier extubation,more safety and economy.
Objective:To compare the effects of two anesthetic techniques in major hepatic by the amounts of intravenous anesthetic agents and vecutonium,heart(HR),mean arterial pressure(MAP)and the time of stopping propofol to extubation.Methods: Fifty-eight patients who were undergoing elective major liver resection were randomly divided into two groups:intubation total intravenous anesthesia group(groupⅠ)and combined general-epidural anesthesia group(groupⅡ).In combined general-epidural anesthesia group epidural puncture was performed at T_(8-9)or T_(9-10).After catheter was fixed,2%lidocaine 4ml were infused into epidural,when the epidural anesthesia was working the general anesthesia was induced.In both groups,anesthesia was induced with midazolam,vecuronium,fentanyl and maintained with propofol.Vecuronium was given when necessary.In combined general-epidural anesthesia group,before skin incision 1% ropivacaine(50mg)was given through epidural catheter and the same dosage was given in every 2 hours.The total volumes of ropivacaine were recorded.In the groups, electrocardiogram,non-invasively arterial pressure,arterial oxygen saturation,airway pressure and urine production were monitored continuously.Fentanyl and vecuronium were stopped 30 minute before the end of operation.Propofol was stop when closing peritoneum.Total volumes of propofol,fentanyl,vecuronium and operation's times, times of stopping -propofol to extubation and whether having awareness at interoperation,whether having pain were all recored in both groups.Results:In both groups none of patient has awareness and pain.The amounts of fentanyl,vecuronium, propofol and the cost in total intravenous anesthesia group were significantly higher than combined general-epidural anesthesia group(P＜0.05),the time of stopping-propofol to extubation is also longer than it(P＜0.05).In the combined general-epidural anesthesia group,the change of MAP during operation is insignigicant compare to baseline,but it increase significantly in the total intravenous anesthesia.Conclusions:Combined general-epidural anesthesia in hepatectomy can decrease the amount of fentanyl, vecuronium and propofol and more stability of hemodynamic,earlier extubation,more safety and economy.
引文
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[2]刘俊杰,赵俊,主编.现代麻醉学[M].第二版.北京:人民卫生出版社,1997:102-136
[3]Weissman C.The metabolic response to stress:an overview and update[J].Anesthesiology.1990,73:308-327
[4]Naito Y,Tamai S,Shingn K,et al.Responses of plasma Adrenocorticotropichomdne.Cortisol and cytokines during and after upper abdominal surgery[J].Anesthesiolgy,1992,77:426-431
[5]Schulze S.Humonal and neural mediators of the systemic response to surgery[J].DanMed Bull.1993,30:81-89
[6]Chambrier C.Epidural anesthesia and metabolic response to surgical stress[J].Ann FrAnesth Reanim,1992,11(6):636-643
[7]Curatole M,Schnider TW.Petersen Falix S,et al.A direct search procedure to optimisecombinations of bupivacaine,fentanyl and clonidine for postoperature analgesia[J].Anesthesiology,2000,92:325-337
[8]齐琰琴,王天龙,杨拔贤等.不同麻醉下子宫切除术病人围术期应激反应与纤溶功能的变化[J].中华麻醉学杂志,2005,25(5):326-329
[9]曲冬梅,金永芳,叶铁虎等.全麻复合硬膜外阻滞对胸科手术应激反应的影响[J].中华医学杂志,2003,83(5):408-411
[10]白永,马琼,苏玉等.中胸部硬膜外阻滞对气管插管反应的影响[J].中华麻醉学杂志,2001,21(11):685
[11]钱燕宁,尹宁,林桂芳.硬膜外阻滞与静脉复合麻醉对上腹部手术病人血浆去甲肾上腺素含量的影响[J].临床麻醉学杂志,1995,11:206
[12]徐道妙.围麻醉期应激反应及其调控[J].国外医学麻醉学与复苏分册.1995,16:207-208
[13]杨钢,主编.人体内分泌生理及其异常[M].第1版.天津:天津科学技术出版社,1980
[14]陈修,主编.心血管药理学[M].第2版.北京:人民卫生出版社,1997,251-255
[15]林桂芳.应激反应的调节与控制[J].中华麻醉学杂志,1998,18(7):447
[16]Woiciechowsky C,Schoning B,Wolfgang RL,et al.Mechanisms of brain-m ediatedsystemic anti-innammatory syndrome causing immunodepression[J].J Mol Med,1999,77:769-80
铩颷17]季恒,陈昆周,杨晏芳,等.硬膜外阻滞加气管插管内全麻与单纯气管插管内全麻用于胃切除的对比研究[J].中华医学杂志,1995,15(2):74
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