全麻与硬膜外复合全麻对开胸手术患者术后并发症影响的比较  

Comparison of effects of general anesthesia versus combined epidural-generai anesthesia on postoperative complications in patients undergoing thoracic surgery

作　　者：周岩[1] 王东信[1] 张锋[1] 

机构地区：[1]北京大学第一医院麻醉科,100034

出　　处：《中华麻醉学杂志》2015年第12期1417-1421,共5页Chinese Journal of Anesthesiology

摘　　要：目的比较全麻与硬膜外复合全麻对开胸手术患者术后并发症的影响。方法拟行开胸手术患者221例，性别不限，年龄18～80岁，体重36～100kg，ASA分级Ⅰ-Ⅲ级，采用随机数字表法，将其分为2组：硬膜外复合全麻组（GE组，n=112）和全麻组（GA组，n=109）。再将患者分为高危人群和低危人群。麻醉诱导：靶控输注瑞芬太尼，静脉注射异丙酚、舒芬太尼和罗库溴铵，置入双腔支气管导管，行机械通气，维持P_ET CO2 30～40mmHg。麻醉维持：吸人1％七氟醚，靶控输注瑞芬太尼，静脉输注异丙酚，间断静脉注射舒芬太尼；GE组硬膜外输注2％利多卡因4ml／h，GA组以相同的速率硬膜外输注生理盐水；术中维持BIS值40～60。术毕采用0．125％罗哌卡因＋舒芬太尼0．5μg／ml（用生理盐水稀释至250m1）行硬膜外自控镇痛，背景输注速率4ml／h，PCA剂量2ml，锁定时间20min，维持VAS评分≤4分。VAS评分≥5分时，静脉注射舒芬太尼5μg进行镇痛补救。记录术后镇痛补救情况、术后住院时间、术后住院期间并发症（心血管事件、心功能不全、急性冠脉综合征、肺部感染、脑卒中和短暂性脑缺血发作）发生情况和术后30d内死亡情况。结果与GE组比较，GA组术后心血管事件和房颤的发生率降低（P〈0．05）。高危患者中，与GE组比较，GA组术后住院时间缩短，术后房颤发生率降低（P〈0．05）。低危患者中，与GE组比较，GA组术后住院时间缩短（P〈0．05），术后并发症的发生率、术后镇痛补救率和病死率差异无统计学意义（P〉0．05）。结论与硬膜外复合全麻相比，开胸手术患者采用单纯全麻可降低术后并发症发生机率，对于术前合并基础疾病的高危患者更具优势。Objective To compare the effects of general anesthesia versus combined epidural- get, eral anesthesia on postoperative complications in the patients undergoing thoracic surgery. Methods Two hundred twenty-one patients of both sexes, aged 18-80 yr, weighing 36-100 kg, of American Society of Anesthesiologists physical status Ⅰ -Ⅲ , scheduled for elective thoracic surgery, were randomly divided into either combined epidural-general anesthesia group （ group GE, n = 112） or general anesthesia group （group GA, n = 109）. The patients were further allocated to high-risk population and low-risk population. Anesthesia was induced with target-controlled infusion of remifentanil and iv injection of propofol, sufentanil and rocuronium. A double-lumen endotracheal tube was placed, and the patients were mechanically ventilated. Partial pressure of end-tidal CO2 was maintained at 30-40 mmHg. Anesthesia was maintained with inhalation of 1% sevoflurane, target-controlled infusion of remifentanil, iv infusion of propofol, and intermittent iv boluses of sufentanil. 2% lidocaine 4 ml/h was infused epidurally in group GE, and normal saline 4 ml/h was given in group GA. Bispectral index value was maintained at 40-60 during surgery. Patient-controlled epidural analgesia （PCEA） was performed after surgery. PCEA solution contained 0.125% ropivacaine and sufentanil 0.5 μg/ml （ in 250 ml of normal saline）. The PCEA pump was set up to deliver a 2 ml bolus dose with a 20-min lockout interval and background infusion at 4 ml/h, and visual analogue scale （VAS） score was maintained less than 4. When VAS score ≥ 5, sufentanil 5 μg was injected intravenously as the rescue analgesic. The requirement for rescue analgesics after surgery, length of hospital stay after surgery, complications during postsurgical hospital stay （cardiovascular events, cardiac insufficiency, acute coronary syndrome, pulmonary infection, stroke, transient cerebral ischemic attack） , and death within 30 days after surgery were recorded. Results

关 键 词：麻醉 全身 麻醉 硬膜外 手术后并发症 胸外科手术 

分 类 号：R614[医药卫生—麻醉学]