靶控输注异丙酚复合硬膜外阻滞用于重症肌无力手术麻醉的研究  

Clinical Research of Anaesthesia for Myasthenia Gravis Thymusectomy by Target Controlled Infusion of Propofol Combined with Epidural Block

作　　者：余健[1] 嵇富海[1] 王擒云[1] 杨建平[1] 

机构地区：[1]苏州大学附属第一医院麻醉科,江苏苏州215006

出　　处：《苏州大学学报（医学版）》2007年第4期595-598,共4页Suzhou University Journal of Medical Science

摘　　要：目的研究靶控输注（TCI）异丙酚＋硬膜外阻滞对重症肌无力（MG）胸腺切除术及术后恢复的影响。方法靶控输注组（T组）10例MG患者T5-6硬膜外阻滞后咪唑安定、芬太尼、异丙酚诱导气管插管,术中以3μg/ml为血浆靶浓度持续异丙酚输注;对照组（C组）25例,硬膜外阻滞后咪唑安定、芬太尼、硫喷妥钠或异丙酚、阿曲库铵诱导气管插管术中N2O和安氟醚维持全麻。于术前（t1）、插管后1 min（t2）、劈开胸骨（t3）、胸腺切除（t4）、缝皮（t5）时测定心率（HR）、脉搏血氧饱和度（SpO2）、平均动脉压（MAP）、呼气末CO2分压（PETCO2）的变化和T组术中尺神经4个成串刺激（TOF）;记录术毕清醒睁眼和拔管时间;观察术后并发症。结果术中两组HR、MAP、SpO2、PETCO2均在正常范围,TOF比率（T4/T1）为0.15-0.45;T、C组术毕清醒时间分别为（8.2±1.3）min和（9.6±2.1）min（P〉0.05）;拔管时间T组为（36.4±5.8）min,C组为（42.7±6.2）min（P〈0.05）;C组术后发生肌无力危象3例,死亡1例,肺不张1例,肺炎2例,气管切开3例,T组未发生上述并发症。结论异丙酚靶控输注维持浅全麻复合硬膜外阻滞用于MG手术,麻醉平稳,术后呼吸影响小,围手术期并发症少,是一种安全可靠的麻醉方法。Objective To discuss the effect of TCI （target controlled infusion） of propofol combined with epidural block to the thymusectomy and postoperative recovery of MG （myasthenia gravis）. Methods The T （TCI） group patients （ n = 10） were given tracheal intubation by being induced with midazolam, fentanyl, propofol and were infused the target concetration of propofol 3μg / ml after epidural block at T5-6 The C （control） group patients （n = 25） were given tracheal intubation by inducing with midazolam, fentanyl, penthiobarbital sodium, atracurium or propofol and N2O and enflurane was used to maintain general anesthesia during the period of operation. To monitor the change of HR, SpO2, MAP, PETCO2 at preoperation （t1）, lmin after tracheal intubation （t2）, the sternum （t3）, thymectomy （t4）, skin closure （ts） were separated and the train-of-four（TOF） stimulus of ulnar nerve in T group was monitored. Were observed The time of postoperative awakening, tracheal extubation postoperative complications were observed. Results The HR, MAP, SpO2, PETCO2 between two groups at t1, t2, t3, t4 and t5 belonged to normal limits, the TOF rate（T4/T1 ） were 0.15 -0.45 during operation. The postoperative awakening time in two groups was （8.2 ± 1.3）/（9.6 ± 2.1）min respectively（ P 〉0.05）. The time of tracheal extubation in two groups was （36.4 ± 5.8） / （42.7±6.2） min respectively（ P 〈 0.05）. Complications in C group： myasthenic crisis in 3 cases, death, in 1 case, pneumonia in 2 cases, incision of trachea in 3 cases. There was no complication in T group after operation. Conclusion The technique of TCI of propofol combined with epidural block for thymusectomy in myasthenia gravis is safe balanced anesthesia as it provides optimal operating conditions and resulted in fewer perioperative complications.death, in 1 case, pneumonia in 2 cases, incision of trachea in 3 cases. There was no complication in T group after operation. Conclusion The technique of TCI of

关 键 词：重症肌无力 胸腺切除术 异丙酚 靶控输注 

分 类 号：R746.1[医药卫生—神经病学与精神病学] R614.27[医药卫生—临床医学]