结肠部分切除患者胸段硬膜外麻醉对胃粘膜内pH值的影响  

Effects of thoracic epidural anesthesia on the intramucosal pH value

作　　者：王焕亮[1] 孙保柱[1] 王春玲[1] 张丽[1] 

机构地区：[1]山东大学齐鲁医院麻醉科,山东济南250012

出　　处：《山东大学学报（医学版）》2006年第12期1281-1283,1288,共4页Journal of Shandong University:Health Sciences

摘　　要：目的：探讨胸段硬膜外麻醉（TEA）对结肠部分切除患者胃粘膜内pH值（pHi）的影响。方法：选择30例ASAⅠ～Ⅱ结肠部分切除患者随机分入TEA组（T组，n=15）和对照组（C组，n=15），胸段硬膜外间隙分别注入0．5％布比卡因8ml或等量生理盐水。硬膜外注药前、注药后60、120、180、240min胃张力计测定胃粘膜内二氧化碳分压（PiCO2），并计算。同时，测定血浆皮质醇和血糖浓度。结果：在180、240时，两组患者P_m和差异显著．（P〈0．05），C组pHi最大下降幅度（0．16±0．04）较T组（0．07±0．05）显著（P〈0．01）。C组10例、T组2例发生pHi〈7．32（P〈0．01）。两组各时间点血浆皮质醇和血糖浓度差异显著（P〈0．05～0．01）。pHi与血浆皮质醇浓度呈显著负相关（r=-0．58，P〈0．01）。结论：TEA能减轻腹腔手术创伤引起的pHi下降，改善内脏组织灌注。Objective： To investigate the effect of thoracic epidural anesthesia （TEA） on the intramucosal pH （pHi）. Methods： Thirty ASA Ⅰ -Ⅱ patients who were going to undergo colectomy randomly were divided into TEA and control groups. 0.5 % bupivacanine of 8 ml or isotonic sodium chloride solution was injected into the epidural space. Gastric mucosal tonometry was placed into the stomach to measure the intramucosal CO2 （ PiCO2 ） and the pHi was calculat- ed before and 60, 120, 180, 240 minutes after epidural injucation. Meanwhile, the concentration of corticoserone and blood glucose were titrated. Results： pHi and PiCO2 had a statistical significance between the groups of 180 and 240 minutes, and the maximal pHi significantly decreased （ P 〈 0.01 ） in the control group （0.16 ± 0.04） compared with that in the TEA group （0.07 ± 0.05）. There were 10 patients in the control group and 2 in the TEA group whose pHi 〈 7.32 at the end of the study （ P 〈 0.01 ）. There were significant differences between groups in the concentration of corticoserone and blood glucose （ P 〈 0.05 - 0.01 ）. A negative correlation was established between the pHi and the concentration of corticoserone（ r = -0.58, P 〈 0.01 ）. Conclusion： TEA can prevent the decrease of pHi induced by surgical stress and increase the flow of visceral perfusion.

关 键 词：麻醉 硬膜外 胃粘膜 胃液酸度测定 腹腔手术 

分 类 号：R614.4[医药卫生—麻醉学]