硬膜外复合浅全麻对上腹部手术后患者自控硬膜外镇痛的影响  

Effects of combined epidural with general anesthesia on postoperative self-controlled epidural analgesia in patients with upper abdominal surgery

作　　者：俞莹芳[1] 白浪[1] 陈佳瑶[1] 周守静[1] 

机构地区：[1]复旦大学附属华山医院麻醉科,上海200040

出　　处：《上海医学》2007年第1期28-30,共3页Shanghai Medical Journal

摘　　要：目的与静吸复合全麻相比,观察硬膜外复合全麻对上腹部手术后患者应用自控硬膜外镇痛(PCEA)质量的影响。方法37例择期行胃癌根治术的患者,美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级,年龄≤70岁,随机分为全麻组(G组,18例)和硬膜外复合浅全麻组(EG组,19例)。两组均在术毕保留硬膜外导管行患者PCEA。于术后6、12、24及48 h记录安静时视觉模拟(VAS)评分及硬膜外镇痛药在术后2 d的用量。结果两组患者的年龄、性别、体重和手术时间的差异无统计学意义(P值均>0．05),G组术中芬太尼用量为(0．41±0．08)mg,明显多于EG组的(0．24±0．03)mg(P<0．05);EG组术后12和24 h VAS评分分别为3．4±2．5和3．1±2．1,明显低于G组的4．5±1．5和4．2±1．0(P值均<0．05);且术后1、2 d EG组镇痛药用量为(55．2±12．9)和(39．9±4．2)mL,明显少于G组的(67．5±9．0)和(52．4±8．0)mL(P值均<0．05)。结论与单纯静吸复合全麻相比,硬膜外复合浅全麻可以显著提高手术后24 h的PCEA的镇痛质量,并减少手术后2 d的镇痛药用量。Objective To compare the effect of combined epidural/general anesthesia with general anesthesia alone on postoperative self-controlled epidural analgesia. Methods A randomized, controlled, prospective clinical trial was conducted. Thirty-seven ASA Ⅰ-Ⅱ patients（≤70 years old） scheduled for gastrectomy were randomly allocated into two groups： general anesthesia group（G group, n = 18） and combined epidural/general anesthesia group（EG group, n = 19）. Self-controlled epidural analgesia was used and consumption of analgesics was recorded 2 days postoperatively（POD） with retaining of epidural canula, the quality of analgesia（visual analogue score） 6, 12, 24, 48 h postoperatively at rest were also evaluated. Results Cumulative dosage of fentanyl during operation in G group [（0.41±0.08） mg] was higher than that in EG group [（0.24±0.03） mg]. VAS in EG group was significantly lower than that in G group 12 and 24 hours postoperatively（ 12 h： 3.4±2.5 vs 4.5±1.5 ; 24 h： 3.1±2.1 vs 4.2±1.0）. The total analgesic consumption was significantly less in EG group [POD 1 ： （55.2±12.9） mL vs （67.5 ± 9.0） mL; POD 2：（39.9± 4.2） mL vs （ 52.4 ±8.0） mL]. Conclusions Combined epidural/general anesthesia can improve the quality of self-controlled epidural analgesia in POD 1 and reduce the consumption of analgesics 2 days postoperatively.

关 键 词：硬膜外复合全麻 患者自控镇痛 上腹部手术 超前镇痛 

分 类 号：R614[医药卫生—麻醉学]