硬膜外联合全身麻醉对老年腹部手术患者内脏氧合的影响分析  

Analyse the effects of general anesthesia combined with epidural anesthesia for elderly patients with abdominal operation oxygenation

作　　者：马国才[1] 史静[2] 王远胜[1] 闵振兴[1] 段雪辉[3] 

机构地区：[1]江门市中心医院麻醉科,广东江门529000 [2]贵阳医学院附属医院麻醉科,贵阳550004 [3]江门市中心医院消化内科,广东江门529000

出　　处：《中国医学前沿杂志（电子版）》2014年第7期138-141,共4页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的探讨硬膜外联合全身麻醉对老年腹部手术患者内脏氧合的影响。方法将80例老年腹部手术患者随机分为对照组与观察组,每组各40例。对照组患者采用单纯全身麻醉,观察组患者采用硬膜外联合全身麻醉。比较两组患者麻醉诱导前(T0)、气管插管后2分钟(T1)、手术持续1小时(T2)、手术持续2小时(T3)以及手术持续3小时(T4)的心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、血氧饱和度(SpO2)、pH、动脉血氧分压(PaO2)、碱剩余(BE)以及血乳酸浓度(Lac)。结果两组患者气管插管后2分钟时HR比较差异具有显著性(P<0.05);观察组患者气管插管后2分钟时MAP变化组内比较差异均具有显著性(P<0.05);对照组患者手术持续3小时后Lac、BE组间及组内比较差异均具有显著性(P<0.05);对照组患者pH水平变化在手术持续2、3小时时组间及组内比较差异均具有显著性(P<0.05)。结论相比于单一的全身麻醉,硬膜外联合全身麻醉对机体气管插管反应的影响较小,且对于长时间麻醉,硬膜外联合全身麻醉能够明显缓解内脏氧合失当等问题。Objective To investigate the effects of general anesthesia combined with epidural anesthesia for elderly patients with abdominal operation oxygenation. Method 80 cases of elderly patients with abdominal operation were randomly divided into control group and observation group, 40 cases in each. The control group used simple general anesthesia, the observation group was treated with epidural combined anesthesia. Compared the two groups before induction of anesthesia（T0）, 2 minutes after intubation（T1）, duration of operation 1 hour（T2）, 2 hours（T3） and the operation continued operation for 3 hours（T4） of heart rate（HR）, mean arterial pressure（MAP）, central venous pressure（CVP）, oxygen saturation（SpO2）, pH, arterial partial pressure of oxygen（PaO2）, base excess（BE） and blood lactate concentration（Lac）. Result The two groups were statistically significant at 2 minutes after intubation in patients with HR difference（P〈0.05）; the patients in observation group at 2 minutes after intubation MAP variation within group differences were statistically significant（P〈0.05）; Lac, BE group after operation for 3 hours and within group differences were all statistically significant（P〈0.05）; control group pH level change for 2, 3 hours between group and within group differences were statistically significant in the operation（P〈0.05）. Conclusion Compared to the single general anesthesia, smaller effects of epidural anesthesia combined with general anesthesia on the tracheal intubation, and for a long time of anesthesia, epidural anesthesia combined with general anesthesia can reduce the visceral oxygenation improper.

关 键 词：硬膜外麻醉 全身麻醉 老年腹部手术 内脏氧合 

分 类 号：R614[医药卫生—麻醉学]