气管内联合硬膜外麻醉用于上腹部手术的超前镇痛

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1、气管内联合硬膜外麻醉用于上腹部手术的超前镇痛.16.中国实用医药2009年9月第4卷第25期ChinaPracMed,Sep2009,Vo1.4,No.25气管内联合硬膜外麻醉用于上腹部手术的超前镇痛余涛郑祥德【摘要】研究气管内联合硬膜外麻醉应用于上腹部手术中,硬膜外用药的时问不同,全麻诱导及维持的药物不同对术后镇痛的影响.方法将120例上腹部手术患者随机分为A,B,C三组,每组40例.A组:术前经T硬膜外腔注入2%利多卡因和0.25%丁卡因混合液8ml,再经硬膜外腔注入曲马多1ms/kg,全麻诱导药物为芬太尼4g/kg,丙泊酚1—2ms/kg,咪唑安定0.02—0.04ms/kg

2、,维库溴胺0.1ms/kg.B组:全麻诱导及维持药物中均不使用芬太尼,用利多卡因1mg/kg代替,其余同A组.C组:在T8间硬膜外穿刺成功后行全身麻醉,诱导及维持药物同A组,切皮后90min,经硬膜外注入2%利多卡因和0.25%丁卡因混合液8IIll,再经硬膜外腔注入曲马多1mg/kg.分别观察各组切皮前后血流动力学变化,于术毕4,8,24,48h观察VAS评分,镇痛药的用量以及术后恶心,呕吐,烦躁不安,皮肤瘙痒等指标.结果A组术后镇痛药用量最少,镇痛效果最好;B组和C组在VAS评分,镇痛药的用量及毒副作用方面无明显区别.结论气管内联合硬膜外麻醉用于上腹部手术时,硬膜外麻醉与芬太尼

3、同时使用术后镇痛效果最好.【关键词】超前镇痛;气管内麻醉;硬膜外麻醉;上腹部手术PreemptiveAnalgesiaOfEndotracheaiAnesthesiaCombinedWithEpiduralAnesthesiaDuringTheOp?erationOnUpperAbdominalRegionYUTao,ZHENGXiang-de.Thedepartmentofanesthesiologyofdazhoucentralhospital,sichuanprovince,635000,China【Abstract】ObjectiveToinvestigatetheeffe

4、ctofpostoperativeanalgesiawithdifferentialtimeofepi—duralmedication,differentialderivationandmaintainedmedicineofgeneralanesthesia,duringtheoperationonupperabdominalregionwithendotrachealanesthesiacombinedwithepiduralanesthesia.Method120caseswereseperatedtothreegroups(A,B,C)inrandom,eachgrouph

5、ad40cases.GroupA:influxmixedliquorof2%Lidoeaineand0.25%Tetracaine8mltocavitasepiduralisthroughT8.9;afterthatinfluxTramadoltocavitasepiduralis,1mg/kg;revulsiveofgeneralanesthesiawasFentanyl4uS/kg,Propofol1-2ms/kg,Midazolam0.02.04ms/kg,VecuroniumBromide0.1ms/kg.GroupB:duringthederivationandmaint

6、ainofgeneralanesthesia,Fentanylwasnotused,replacedbyLidocaine1ms/kg,othe~weresametogroupA.GroupC:afterepiduralpuneturationthroughT8,thenstartthegeneralanesthesia,samedtogroupA,sliveredskin,90minlat?er,influxmixedliquorof2%Lidocaineand0.25%Tetracaine8mltocavitasepiduralisthroughTs.;afterthatinf

7、luxTramadoltoeavitasepiduralis,1ms/kg;toobservethedifferenceofthehemodynamicsbe~reandaftertheskinsliveredseperatedly,toobserveindexesincludedVASscore,thedosisofpain-killerandpostoperativenausea,emesis,dysphoria,itchofskinetal,4,8,24,48h