静脉辅助用药和阑尾系膜封闭对抗阑尾牵拉反应的效果比较  

作　　者：夏富杰 

机构地区：[1]山东省临邑县中医院麻醉科,山东德州251500

出　　处：《中国农村卫生》2013年第03Z期328-329,共2页

摘　　要：目的阑尾炎是最常见的疾病之一，国内报告发生率为1％。死亡率为0．1％-0．5％．目前在国内基层医院，阑尾切除术大部分选择连续硬膜外麻醉，但硬膜外麻醉不能有效抑制术中阑尾及其系膜的牵拉反应。有必要寻找一种解决牵拉反应的办法。方法180例急、怪陆阑尾炎，随机均分为观察组和对照组。对照组为静脉注射芬氟合剂组，观察组为阑尾系膜封闭组。两组均在相同的硬膜外麻醉下行阑尾切除术。同一观察指标进行评定。结果两组患者年龄、身高、体重、性别、疾病类型和手术种类差异无统计学意义（P〉0．05）。切开牵拉腹膜、手术切除阑尾时观察组患者SBP、DBP、HR等血液动力学指标无显著改变；对照组患者SBP、DBP、HR较术前明显波动，两组比较差异有显著性（P〈0．05），见表2。术中发生0、Ⅰ、Ⅱ、Ⅲ级阑尾牵拉反应，观察组分别为72、12、6、0例，对照组分别为0、20、11、59例。两组患者术中牵拉反应分级情况差异有显著性（P〈0．05）。结论阑尾系膜局麻药封闭能明显降低阑尾牵拉反应，取得了令人满意的麻醉效果。Objective to appendicitis is one of the most common diseases, the incidence was 1%. The mortality was 0.1%-0.5%.At present in domestic hospitals, appendectomy mostly continuous epidural anesthesia, but the epidural anesthesia can not effectively inhibit the appendix and its mesentery intraoperative traction reaction. It is necessary to find a solution to the stretch reaction method.Methods 180 cases of acute, chronic appendicitis, were randomly divided into observation group and control group. The control group were intravenous Innovar group, the observation group for the mesoappendix closed group. The two groups were the same for epidural anesthesia in appendectomy. The same observation indexes.Results there were no significant in two groups of patients with age, height, weight, sex, type of disease types and operation difference （ P〉0.05 ）. Incision and distraction peritoneal, operation excision appendix when patients in the observation group SBP, DBP, HR and other hemodynamic parameters did not change significantly; the patients of control group SBP, DBP, HR were markedly fluctuation, there was significant difference between the two groups （ P〈0.05 ）, see table 2. 0, Ⅰ, Ⅱ,Ⅲ appendix traction response occurred during the operation, the observation group were 72, 12, 6, 0 cases, the control group were 0, 20, 11, 59 cases.Patients in the two groups of traction reaction grade difference was significant （ P〈0.05 ）. Table 1. Conclusion the mesoappendix anesthetic closed can significantly reduce the stretch reaction appendix, achieved satisfactory anesthesia effect.

关 键 词：抗阑尾牵拉反应 阑尾系膜封闭 静脉辅助用药 连续硬膜外麻醉 血液动力学指标 阑尾切除术 患者年龄 术中牵拉反应 

分 类 号：R574.61[医药卫生—消化系统]