胸段硬膜外阻滞复合全身麻醉中鼓膜温和直肠温的变化  

Changing Pattern of Core Temperature during Thoracic Epidural Block Combined with General Anesthesia and the Agreement between Rectal and Tympanic Temperature

作　　者：张俊峰[1] 仓静[1] 薛张纲[1] 蒋豪[1] 

机构地区：[1]复旦大学附属中山医院麻醉科,上海200032

出　　处：《复旦学报（医学版）》2005年第2期231-233,共3页Fudan University Journal of Medical Sciences

摘　　要：目的　研究胸段硬膜外阻滞复合全身麻醉中鼓膜温和直肠温的变化规律 ,并以鼓膜温为标准中心体温 ,比较直肠温用于临床监测中心体温的有效性。方法　选择食管癌根治术患者 10例 ,均采用胸段硬膜外阻滞复合全身麻醉。诱导前 2 0min开始每间隔 10min记录鼓膜温 ,诱导后开始每间隔 10min记录直肠温。结果　麻醉诱导后鼓膜温呈进行性降低趋势 ,鼓膜温的降温速度和降低值在各时间点之间的差异有统计学意义 (P <0 .0 1) ;直肠温与鼓膜温之间有良好的相关性。结论　胸段硬膜外阻滞复合全身麻醉下中心体温会进行性降低 ,麻醉后第 1小时降温较快 ,此后相对缓慢但仍持续下降 ;直肠温可反映鼓膜温的变化趋势 ,但它比鼓膜温要偏高。Purpose To study the changing pattern of core temperature during thoracic epidural block combined with general anesthesia and assess the agreement between rectal and tympanic temperature. Methods Ten ASA Ⅰ～Ⅱ patients undergoing elective surgery for carcinoma of oesophagus were enrolled in this study.Epidural block was performed at T 7～8.General anesthesia was induced with fentanyl 3 μg/kg,thiopentone 3～5 mg/kg and succinylcholine 1.5 mg/kg.Anesthesia was maintained with isoflurance,vecuronium and thoracic epidural block.Bispectral index(BIS) was maintained at 45～60.Tympanic and rectal temperature were recorded perioperatively every 10 min. Results Tympanic temperature decreased progressively during combined anesthesia and decreased (1.34±0.27),(1.91±0.33) and (2.39±0.44) ℃ within 1,2 and 3 hours,respectively.There was significant difference among these time points(P<0.01).The decreasing rate of tympanic temperature was (1.33±0.13),(0.54±0.17) and (0.48±0.19) ℃/h during the first,second and third hour,respectively.Rectal temperature correlated well with tympanic temperature and the coefficient of determination (R2) was 0.95.The bias for rectal temperature compared with tympanic temperature was (0.52±0.16) ℃( x—±s). Conclusions Perioperative mild hypothermia develops progressively during thoracic epidural block combined with general anesthesia,tympanic temperature decreases at a higher rate during the first hour than that of the following hours.Rectal temperature can reflect the changing trends of tympanic temperature,but it is a little higher than tympanic temperature.

关 键 词：硬膜外阻滞复合全身麻醉 鼓膜温 直肠温 胸段 中心体温 食管癌根治术 变化规律 临床监测 方法选择 麻醉诱导 降温速度 进行性 统计学 相关性 麻醉后 记录 间隔 

分 类 号：R657.4[医药卫生—外科学] R443.5[医药卫生—临床医学]