摘要
目的明确全麻复合胸段硬膜外阻滞和单纯全麻对食管癌根治术患者术中氧供需平衡指标:中心静脉血氧饱和度(central venous oxygen saturation,ScvO2)、中心静脉-动脉二氧化碳分压差值(central venous-toarterial difference of carbon dioxide,Pcv-aCO2)和中心静脉-动脉乳酸差值(difference between central venous and arterial lactate,Dcv-aLac)及术后并发症的影响。方法将60例择期行右胸、上腹正中两切口食管癌根治术(Ivor Lewis手术)的患者随机分为2组:单纯全麻组(GA组,n=30)和全麻复合硬膜外麻醉组(GE组,n=30)。两组患者的全麻诱导基本一致,术中维持相同的麻醉深度,术后GA组采用患者自控静脉镇痛(patientcontrolled analgesia,PCIA),GE组采用自控硬膜外镇痛(patient-controlled epidural analgesia,PCEA)。术前记录患者一般资料,术中连续监测心率(heart rate,HR)、平均动脉压(Mean arterial pressure,MAP)及ScvO2等。患者入室后(T1)、关腹前(T2)、关胸前(T3)以及出麻醉后监控室(postanethesia care unit,PACU)前(T4)4个时间点分别抽取中心静脉血和动脉血行血气分析,计算Pcv-aCO2、Dcv-aLac。记录患者术后第1天(POD1)和第2天(POD2)的疼痛视觉模拟评分(visual analogue scale,VAS),并随访术后并发症情况。结果两组患者的一般资料差异无统计学意义。与GA组相比,GE组术中HR、MAP显著下降(P<0.05),但其波动仍在正常范围内。在T4时间点,GE组ScvO2显著高于GA组(P<0.05),而其余3个时间点均无显著差异。血气分析结果显示,T2、T3、T4时间点上,GE组患者Pcv-aCO2、Dcv-aLac均显著低于GA组(P<0.05)。术后并发症发生率方面,GE组也显著低于GA组(P<0.05)。结论与单纯全麻相比,全麻复合胸段硬膜外阻滞能够提高ScvO2,显著降低Pcv-aCO2和Dcv-aLac,从而改善患者术中氧供需平衡,并降低术后相关并发症的发生率。
Objective To explore the effect of general anesthesia combined with thoracic epidural anesthesia and general anesthesia on intraoperative oxygen balance related index：central venous oxygen saturation（ScvO2）,central venous-to-arterial difference of carbon dioxide（Pcv-aCO2）and difference between central venous and arterial lactate（Dcv-aLac）and postoperative complications in patients undergoing esophageal cancer surgery. Methods Sixty patients who received Ivor Lewis surgery were randomly divided into two groups：general anesthesia group（GA,n=30）and general anesthesia combined with thoracic epidural anesthesia（GE,n=30）.The induction of general anesthesia was basically consistent,and the same depth of anesthesia was maintained in the two groups during the operation.Patient-controlled intravenous analgesia（PCIA）was performed in GA group,and patientcontrolled epidural analgesia（PCEA）was performed in GE group after surgery.Heart rate（HR）,mean arterial pressure（MAP）,ScvO2,ect.were continuously monitored until patients leaved postanethesia care unit（PACU）.Blood was obtained synchronously from central venous and radial artery for blood gas analysis after entering operation room（T1）,before closing abdomen（T2）,before closing the chest（T3）and before leaving PACU,and Then Pcv-aCO2 and Dcv-aLac were calculated.Visual analogue scale（VAS）was recorded in postoperative day 1（POD1）and day 2（POD2）,and incidence of postoperative complications were recorded. Results There was no significant differences in general demographic data and clinical data between two groups.Compared with GA group,HR and MAP significantly decreased in GE group（P〈0.05）,but it was still within the normal range.At the time point of T4,ScvO2 in GE group significantly increased（P〈0.05）compared with GA group,while there was no significant differences in Pcv-aCO2 and Dcv-aLac at the other time points.Blood gas analysis showed that Pcv-aCO2 and Dcv-aLac decreased significantly in GE group at the time points of T2,T3 and T4 compared with GA group（P〈 0.05）,as well as the incidence of postoperative complications（P 〈0.05）. Conclusions Compared with general anesthesia,general anesthesia combined with thoracic epidural anesthesia can effectively increase ScvO2,and decrease Pcv-aCO2 and Dcv-aLac,thereby improving oxygen balance and thus decreasing the incidence of postoperative complications.
出处
《复旦学报（医学版）》
CAS
CSCD
北大核心
2016年第5期550-557,共8页
Fudan University Journal of Medical Sciences
关键词
全麻
胸段硬膜外阻滞
中心静脉血氧饱和度
中心静脉-动脉二氧化碳分压差值
中心静脉-动脉乳酸差值
general anesthesia
epidural anesthesia
central venous oxygen saturation
central venous-to-arterial difference of carbon dioxide
central venous-to-arterial difference of lactic acid
