硬膜外阻滞对老年胸科手术患者中心静脉血氧饱和度的影响  

The effect of thoracic epidural block on central venous oxygen saturation in elderly patients undergoing thoracic surgery

作　　者：陈龙 房孝梅 张茂银[2] 刘功俭[2] 朱煊 陈西艳 

机构地区：[1]江苏省徐州市第六人民医院麻醉科,221006 [2]徐州医学院附属医院麻醉科江苏省麻醉学重点实验室,江苏徐州221002

出　　处：《蚌埠医学院学报》2011年第12期1348-1349,1352,共3页Journal of Bengbu Medical College

摘　　要：目的:观察胸段硬膜外阻滞对老年胸科手术患者中心静脉血氧饱和度(ScVO2)的影响。方法:将ASAⅠ～Ⅱ级择期行胸科手术的食管癌和肺癌患者40例随机均分为2组,分别给予全麻复合硬膜外麻醉(A组)和全身麻醉(B组)。A组在全麻诱导前行硬膜外穿刺,选择T5-6或T6-7间隙,局麻药选用1.5%利多卡因4 ml,确定硬膜外麻醉有效后再行全麻诱导。2组患者全麻诱导均采用静脉注射依托咪酯0.2～0.3 mg/kg、芬太尼3～4μg/kg、顺式阿曲库铵0.15 mg/kg,诱导成功后插入双腔导管,维持采用吸入1%～3%七氟烷,泵入瑞芬太尼并间断静注顺式阿曲库铵。A组持续泵入1.5%利多卡因5～6 ml/h直至手术结束。B组单纯全麻。记录2组术前、术中和手术结束时血流动力学、动脉血氧饱和度和ScVO2。结果:与B组比较,A组术中血流动力学较平稳。2组病例在单肺通气和手术后的ScVO2均比手术前有明显的降低(P<0.01),但B组较A组下降更多。结论:硬膜外阻滞复合全麻可以显著提高胸科手术患者ScVO2,降低氧的消耗。Objective：To explore the effect of thoracic epidural block on central venous oxygen saturation（ScVO2） in elderly patients undergoing chest surgery.Methods：Forty ASA Ⅰ-Ⅱ patients undergoing esophagectomy or lobectomy were randomized to receive either general combined thoracic epidural anesthesia（group A,n=20） or pure general anesthesia（group B,n=20）.In group A,thoracic 5-6 or 6-7（T5-6 or T6-7） vertebral space for puncture and epidural catheter was placed before general anesthesia.A test dose of 4 ml 1.5% lidocaine was given.When correct positioning of the epidural catheter was confirmed,general anesthesia in the two groups was induced with etomidate 0.2-0.3 mg/kg,fentanyl 3-4 μg/kg and syn-atracurium 0.15 mg/kg,anesthesia was maintained with 1%-3% sevoflurane and remifentanil and intermittent intravenous injection bolused of syn-atracurium.One point five percent lidocaine was continuously infused at a rate of 5-6 ml/h during operation in group A.Patients in group B were received only general anesthesia.The hemodynamics,SaO2 and ScVO2 in two groups pre-,intra-and after-operation were recorded.Results：Compared with group B,the hemodynamics in group A was stable.ScVO2 in group A and group B was dropped significantly after operation（P0.01）,but the ScVO2 in group B was droped furtherly.Conclusions：Thoracic epidural block can significantly raise ScVO2 and depress the consumption of oxygen in patients who received chest surgery.

关 键 词：硬膜外阻滞 麻醉 全身 胸科手术 老年 中心静脉血氧饱和度 

分 类 号：R614[医药卫生—麻醉学]