全麻联合硬膜外麻醉对腹部手术患者胃肠道保护作用.pdf

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1、．640．全科医学临床与教育2013年11月第11卷第6期ClinicalEducationofGeneralPracticeNov．2013，Vo1．11，No．6·临床研究·全麻联合硬膜外麻醉对腹部手术患者胃肠道保护作用楼群兵刘宇[摘要】目的比较全麻联合硬膜外麻醉与全身麻醉对腹部手术患者的胃肠道保护作用。方法将接受腹部手术的患者52例随机分为观察组和对照组．观察组患者接受全麻联合硬膜外麻醉，对照组患者接受全身麻醉。两组患者分别于麻醉前、麻醉后30min、手术结束时和术后4h检测两组患者胃黏膜p

2、H值、血清肠脂肪酸结合蛋白(I—FABP)水平，比较两者患者术后胃肠道恢复情况。结果观察组在麻醉后30min、手术结束时和术后4h时胃黏膜pH值高于对照组，血清I-FABP水平明显低于对照组，差异均有统计学意义(t：f别=4．15、5．66、3．92、14．68、12．74、8．64，P均<0．05)；观察组患者术后腹胀评分明显低于对照组，肠鸣音出现时间和肛门排气时间均较对照组明显缩短，差异均有统计学意义(分别=4．00、4．14、4．14，P均<0．05)。结论全麻联合硬膜外麻醉对腹部手术患者的

3、胃肠道保护作用明显。『关键词]全身麻醉；硬膜外麻醉；腹部手术；胃肠道保护作用ProtectiveefectofgeneralanesthesiacombinedwithepiduralanesthesiaonthegastrointestinaltractsinpatientswithabdomenoperationL0UQunbing，LIUYu．DepartmentofAnesthesia，CentralHospitalofYiwu，Yiwu322000，China[Abstract】Obje

4、ctiveTocomparetheprotectiveeffectofgeneralanesthesiacombinedwithepiduralanesthesiaandsin—glegeneralanesthesiaonthegastrointestinaltractsinpatientswithabdomenoperation．MethodsAtotalof52patientswhoreceivedabdomenoperationwererandomlydividedintoobservati

5、ongroupandcontrolgroup．Casesinobservationgroupreceivedgeneralanesthesiacombinedwithepiduralanesthesia，andcasesincontrolgroupreceivedsinglegeneralanesthesia．ThepHvalueofgastricmucousmembrane，intestinalfattyacidbindingprotein(I-FABP)levelinserumweredete

6、ctedrespectivelybeforeanesthesia，at30minutesafteranesthesiaatendoftheoperationandat4hoursafterthe0p—eration．ResultsThepHvalueofgastricmucousmembraneofobservationgroupweresignificantlyhigherthanthatofthecontrolgroupwhileI-FABPlevelofobservationgroupwer

7、esignificantlylowerthanthatofthecontrolgroupwithstatisticdifference(t=4．15，5．66，3．92，14．68，12．74，8．64，P<0．05)．Thescoreofabdomenrepletionofobservationgroupweresignificantlylowerthanthatofcontrolgroupwhilethetimeofboweltoneandthetimeoffirstanalexhaustio

8、nofobserva-tiongroupweresignificantlyhigherthanthatofcontrolgroup(t=4．00，4．14，4．14，P<0．05)．ConclusionGeneralanes—thesiacombinedwithepiduralanesthesiahasremarkableprotectiveeffectonthegastrointestinaltractinpatientswithab—domenoperation．【Keywor