贲门癌根治术中两种麻醉镇痛方案对病人术后康复的影响及其医疗费用比较  

The effect of two analgesia methods for recovery and cost after gastric cardia carcinoma surgeries

作　　者：徐红梅[1] 张跃[1] 钱燕宁[2] 

机构地区：[1]南京医科大学附属淮安市第一人民医院麻醉科,223002 [2]南京医科大学第一附属医院麻醉科,南京210029

出　　处：《实用临床医药杂志》2008年第7期37-39,41,共4页Journal of Clinical Medicine in Practice

基　　金：江苏省卫生厅资助项目(H200705)

摘　　要：目的观察硬膜外自控镇痛和静脉自控镇痛对经腹贲门癌根治术病人术后康复的影响，并将两种方案的医疗费用进行比较。方法ASAⅠ～Ⅱ择期经腹贲门癌根治术患者40例。随机分为两组（n=20）：全凭静脉复合麻醉组（G组）和硬膜外复合全麻组（GE组）。G组采用咪唑安定0．02-0.04mg／kg、阿曲库铵0.6～0.8mg／kg、芬太尼4-6μg／kg、依托咪酯0．3～0．6mg／kg静脉诱导插管；GE组选择T9-10硬膜外阻滞成功后麻醉诱导同G组。两组术中均静脉泵注丙泊酚、卡肌宁维持麻醉，G组泵注瑞芬太尼0．5-1μg／（kg·min）维持镇痛，GE组术中每隔50-60min经硬膜外导管注入1．5％利多卡因5～6mL，必要时静脉给予芬太尼0．1-0．2mg／次。记录术中麻醉药物用量、总麻醉费用和术毕清醒时间（呼唤可睁跟）。术毕即刻G组采用静脉止痛（PCIA），GE组行硬膜外止痛（PCEA）。应用视觉模拟评分法（VAS）评价术后的疼痛程度。观察术后病人的首次肛门排气时间、拔除胃管时间及康复出院时间。统计住院天数及术后医疗费用（术后第一天至出院日的所有费用）。结果两组一般情况和手术时间无统计学差异。GE组术中所用的丙泊酚、卡肌宁剂量少于G组（P〈0．05）；术中总麻醉费用GE组低于G组；胃肠蠕动恢复时间GE组短于G组（P〈0.05）；GE组术后住院天数和医疗费用少于G组（P〈0．05）。结论应用PCEA有利于贲门癌根治术病人的术后康复而且术后医疗费用较低。Objective To compare the effects of defferent patient-controlled analgesia on the cost and recovery after gastric cardia carcinoma surgeries. Methods 40 patients undergoing gastric cardia carcinoma surgeries were randomly divided into two groups with 20 cases each： simple general anesthesia （Group G）, combined general-epidural anesthesia （Group GE）. After operation, group G received PCIA and group GE received PIEA. The visual analogue scale （VAS） 24 h was adopted and the time of first flatus was noted. MAP, HR and ECG were continuously monitored during anesthesia, recorded the cost of anesthesia,the cost in the hospital after operation and the days until the patient leave hospitl. Results The analgesics required and the cost after operation in Group GE were lower than those in group G （P〈0.05）. There was significant difference in the time of recovery of bowel funtion after operation between the two groups （P 〈 0.05）. And also there was significant difference in MAP,HR after intubation. Conclusion Epidural combined with general anesthesia is an effective and economical method of postoperative pain relief after gastric cardia carcinoma surgeries.

关 键 词：全身麻醉 静脉麻醉 复合 硬膜外阻滞 贲门癌根治术 费用 

分 类 号：R614.2[医药卫生—麻醉学]