瑞芬太尼联合依托咪酯全身麻醉复合罗哌卡因硬膜外镇痛对轻中度慢性阻塞性肺疾病患者腹部手术围术期动脉血气分析指标及术后血流动力学指标的影响  

Effects of general anesthesia with remifentanil plus etomidate and epidural analgesia with ropivacaine on perioperative arterial blood gas analysis indexes and postoperative hemodynamic indexes in patients with mild to moderate chronic obstructive pulmonary disease undergoing abdominal surgery

作　　者：吕航宇[1] 李晓云[2] 陈永学[1] 王新波[1] 李建华[1] 未国徽 段静辉[1] 缪芸[1] LYU Hang-yu;LI Xiao-yun;CHEN Yong-xue;WANG Xin-bo;LI Jian-hua;WEI Guo-hui;DUAN Jing-hui;MIAO Yun(Department of Anesthesiology,Handan Central Hospital,Handan 056001,China;Department of Anesthesiology,Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北省邯郸市中心医院麻醉科,邯郸市056001 [2]河北医科大学第二医院麻醉科,石家庄市050000

出　　处：《广西医学》2020年第5期554-558,共5页Guangxi Medical Journal

基　　金：河北省邯郸市科学技术研究与发展计划(1223108156)。

摘　　要：目的探讨瑞芬太尼联合依托咪酯全身麻醉复合罗哌卡因硬膜外镇痛在轻中度慢性阻塞性肺疾病(COPD)患者腹部手术中的应用,及其对患者围术期动脉血气分析指标及术后血流动力学指标的影响。方法将86例进行腹部手术的轻中度COPD患者,随机分为对照组和观察组,各43例。对照组患者采用吸入七氟烷全身麻醉,观察组患者采用瑞芬太尼联合依托咪酯全身麻醉复合罗哌卡因硬膜外镇痛。比较两组围术期动脉血气分析指标及拔除气管导管后的血流动力学指标。结果两组患者在手术期间及麻醉苏醒期的动脉血气分析指标差异均无统计学意义,且动脉血气分析指标均无随时间变化的趋势,分组与时间均无交互效应(均P>0.05)。观察组患者拔管后的收缩压及心率均低于对照组(均P<0.05),而两组拔管后舒张压比较差异无统计学意义(P>0.05)。结论与吸入全身麻醉相比,轻中度COPD患者行腹部手术时采用瑞芬太尼联合依托咪酯全身麻醉复合罗哌卡因硬膜外镇痛,可降低患者拔管后收缩压及心率,且不影响其血气分析指标。Objective To explore the application of general anesthesia with remifentanil plus etomidate and epidural analgesia with ropivacaine, as well as its effects on perioperative arterial blood gas analysis indexes and postoperative hemodynamic indexes(COPD). Methods Eighty-six patients with mild to moderate COPD who underwent abdominal surgery were randomly divided into control group and observation group, with 43 cases in each group. Patients in the control group received general anesthesia with sevoflurane inhalation, and patients in the observation group received general anesthesia with remifentanil plus etomidate and epidural analgesia withropivacaine. Perioperative arterial blood gas analysis indexes and hemodynamic indexes after tracheal extubation were compared between the two groups. Results There was no statistically significant difference between the tow groups in arterial blood gas analysis during operation or emergence from anesthesia, arterial blood gas analysis indexes showed no trend to change with time, and there was no interaction between grouping effect and time effect(all P>0.05). The observation group had lower systolic blood pressure and heart rate after extubation than the control group(all P<0.05), and there was no statistically significant difference in diastolic blood pressure between the two groups(P>0.05). Conclusion For patients with mild to moderate COPD during abdominal surgery, compared to general anesthesia with inhalation anesthetics, general anesthesia with remifentanil plus etomidate and epidural analgesia with ropivacaine can reduce patients′ systolic blood pressure and heart rate after extubation, not affecting their arterial blood gas analysis indexes.

关 键 词：慢性肺阻塞性肺疾病 轻中度 腹部手术 麻醉 瑞芬太尼 罗哌卡因 围术期 动脉血气分析 

分 类 号：R614[医药卫生—麻醉学]