硬膜外阻滞复合全身麻醉在重症肌无力手术中的应用效果  

Application effect of epidural block combined with general anesthesia in patients with myasthenia gravis surgery

作　　者：秦学伟 郑扬 QIN Xuewei;ZHENG Yang(Peking University International Hospital,Beijing 102206,China;不详)

机构地区：[1]北京大学国际医院,北京市102206 [2]费森尤斯医药用品(上海)有限公司,上海市200020

出　　处：《临床合理用药杂志》2020年第22期33-36,共4页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的观察硬膜外阻滞复合全身麻醉在重症肌无力手术中的应用效果。方法选择2015年7月-2018年12月北京大学国际医院收治的拟行胸腺切除+前纵隔脂肪清扫术的重症肌无力患者432例,根据麻醉方法不同分为A组(n=187)和B组(n=245)。A组采用硬膜外阻滞复合全身麻醉,B组采用全身麻醉。比较2组各时点平均动脉压(MAP)、心率(HR)及停药到拔管时间、出室时间、丙泊酚用量。结果A组切皮时及术毕时MAP、HR与术前比较差异无统计学意义(P>0.05);B组切皮时及术毕时MAP和HR均高于术前(P<0.05),且B组高于A组(P<0.01);2组患者均在手术室顺利拔管,A组停药到拔管时间、出室时间均短于B组(P<0.01),丙泊酚用量少于B组(P<0.01);2组患者术后送至重症肌无力中心继续观察24 h后,均未发现肌无力征象及其他不良反应。结论硬膜外阻滞复合全身麻醉用于重症肌无力患者胸腺切除手术具有提前拔管的优势及完善的局部镇痛效果,可提升患者安全性及舒适感,是一种理想的手术麻醉方法。Objective To observe the effect of epidural block combined with general anesthesia in myasthenia gravis surgery.Methods 432 patients with myasthenia gravis admitted to Peking University International Hospital from July 2015 to December 2018 were selected,all patients were treated with surgery,and they were divided into group A(n=187)and group B(n=245)according to different anesthesia methods.Group A received epidural block combined with general anesthesia,and group B received general anesthesia.The average arterial pressure(MAP),heart rate(HR),time from withdrawal to extubation,time to discharge,and the amount of propofol were compared between the two groups.Results Compared with pre-operation,there were no statistically significant difference in MAP and HR between skin incision and after operation in group A(P>0.05);MAP and HR in group B were higher at the time of skin incision and at the end of surgery than before surgery(P<0.05),and group B was higher than group A(P<0.01);the patients in both groups were successfully extubated in the operating room,the time from withdrawal to extubation in group A were shorter than that in group B(P<0.01),and the amount of propofol was less than that in group B(P<0.01);all patients sent to MG center observed closely for 24 hours without signs of myasthenia and other adverse reactions.Conclusion Epidural epidural block combined with general anesthesia for thymectomy surgery has the advantages of early extubation and perfect local analgesia,it can improve the safety and comfort of patients,it is an ideal surgical anesthesia method.

关 键 词：重症肌无力 硬膜外阻滞 盐酸罗哌卡因 麻醉 

分 类 号：R614[医药卫生—麻醉学]