不同麻醉与镇痛方法对行普通胸外科手术的老年患者术后心房颤动发生的影响  

Effects of different anesthesia and analgesia approaches on postoperative onset of atrial fibrillation in elderly patients undergoing general thoracic surgery

作　　者：吴德华[1] 马静雅[1] 徐益萍[1] 吴蔚宇[1] 曹晖[1] 吴镜湘[1] 徐美英[1] WU Dehua MA Jingya XU Yiping WU Weiyu CAO Hui WU Jingxiang XU Meiying.(Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, Chin)

机构地区：[1]上海交通大学附属胸科医院麻醉科,上海200030

出　　处：《上海医学》2016年第10期593-598,共6页Shanghai Medical Journal

基　　金：上海市"科技创新行动计划"医学与农业领域项目(12411952000);上海市胸科医院重大重点项目(2014YCDC20500);上海申康医院发展中心上海市市级适宜技术发展项目(SHDC12014241)资助

摘　　要：目的探讨不同麻醉与镇痛方法对行普通胸外科手术（以下简称普胸手术）的老年患者术后心房颤动（以下简称房颤）发生的影响。方法选取行肺癌根治术或食管癌根治术的患者，美国麻醉医师协会（ASA）分级I或Ⅱ级，年龄60-80岁，体重45-85kg。采用随机区组设计和随机数字法将患者分人3组：全身麻醉＋静脉镇痛组（普通组，456例）；全身麻醉联合椎旁阻滞＋静脉镇痛组（椎旁组，401例），于麻醉诱导后行椎旁阻滞；全身麻醉联合硬脊膜外腔阻滞＋硬脊膜外腔镇痛组（硬膜外组，400例），于麻醉诱导前放置硬脊膜外腔导管。3组患者的麻醉诱导方法相同。普通组术中间断静脉注射舒芬太尼10μg，术后采用静脉镇痛；椎旁组术中必要时静脉注射舒芬太尼10μg，术后镇痛方案同普通组；硬膜外组于硬脊膜外腔导管间断注射0．25％罗哌卡因5mL，术后采用硬脊膜外腔镇痛。记录各组患者术中房颤发生情况，以及术后房颤发生时间和持续时间，以及术后其他心律失常发生情况；记录术后住院时间和术后24、48h时的疼痛视觉模拟评分（VAs评分），观察并记录术后并发症的发生情况。结果普通组、椎旁组、硬膜外组术后总心律失常发生率分别为38．2％（174／465）、37．7％（151／401）、38．3％（153／400），3组间的差异无统计学意义（P值均〉0．05）。3组间术后房颤发生率、术后房颤发生时间和持续时间的差异均无统计学意义（P值均〉O．05），所有房颤患者出院前均恢复窦性心律。3组间室性过早搏动（以下简称早搏）、房性早搏发生率的差异均无统计学意义（P值均〉0．05）。普通组窦性心动过速发生率显著高于椎旁组（P〈0．05），普通组和硬膜外组窦性心动过缓发生率均显著低于椎旁组（P值均〈0．01）。硬膜外组患者住院时间显著长于普通组和椎Objective To investigate the effects of different anesthesia and analgesia approaches on postoperative onset of atrial fibrillation （AF） in elderly patients undergoing general thoracic surgery. Methods In this study, elderly patients （60- 80 years）, American Society of Anesthesiologists （ASA） physical status I or Ⅱ, weighing 45-85 kg, scheduled for elective radical operations for lung or esophageal cancer were randomly divided into 3 groups： general anesthesia ＋ patient controlled intravenous analgesia （PCIA） group （Group G, n = 456）, general anesthesia followed by paravertebral block ＋ PCIA group （Group GP, n = 401）, and generalanesthesia plus epidural block ＋ PCEA group （Group GE, n = 400）. For Group GE, an epidural catheter was inserted before anesthesia induction. For Group GP, 0. 375% ropivacaine was injected for paravertebral block after anesthesia induction. Sulfentanil 10 IJg was intermittently injected intravenously during surgery in group G. Sulfentanil 10 pg was intravenously injected when needed in group GP. 0.25% ropivacaine 5 mL was intermittently injected through the epidural catheter in group GE. The episode of new onset atrial fibrillation and the development of cardio-thoracic and vascular events were recorded during postoperative periods. Postoperative hospital stay, visual analogue scale （VAS） score at 24 hours and 48 hours postoperatively, and postoperative complications were recorded. Results The incidence rates of postoperative cardiac arrhythmia were 38.2% （174/456）, 37.7% （151/401） and 38. 3% （153/400） in groups G, GP and GE, respectively （all P〉O. 05）. There were no significant differences in terms of incidence, onset time, or duration of postoperative AF between groups （all P〉 0.05）. Neither were the incidence of premature ventricular contractions or atrial premature beats （all P〉O. 05）. The heart rhythm of patients with postoperative AF returned to sinus rhythm before discharge from hospital. The incidence of sinus

关 键 词：老年 普胸手术 心房颤动 全身麻醉 椎旁阻滞 硬脊膜外腔阻滞 

分 类 号：R614[医药卫生—麻醉学]