几种联合吸入全麻的临床比较

【作者】 陈丽；

【导师】 刘进；

【作者基本信息】 四川大学 ， 麻醉学， 2004， 硕士

【摘要】 背景和目的 硬膜外阻滞联合全身麻醉在临床上运用越来越普遍,两种方法的联合应用可以相互取长补短,有利于围术期病人的生理调控。但是在这种麻醉方法中,全麻在很大程度上是为了维持患者耐受气管导管。为了使患者更易耐受气管导管,我们设计了气管表面涂抹恩纳、硬膜外阻滞、全身麻醉这三者结合的麻醉方法,并比较了恩纳联合硬膜外阻滞联合全麻、单纯全麻、恩纳联合全麻和硬膜外阻滞联合全麻这四种麻醉方法术中异氟醚的用药量及术后副作用,以求为临床提供一个合理有效的联合麻醉方法。 材料和方法 选择上腹部手术患者60例,ASA Ⅰ～Ⅱ级。随机分为四组:单纯全麻组(GA组);恩纳(2.5%利多卡因与2.5%丙胺卡因的乳剂涂抹于导管上)联合全麻组(GA+GMA组);硬膜外阻滞联合全麻组(GA+EA组);恩纳联合硬膜外阻滞联合全麻组(GA+EMA+EA组)。四组患者术前30分钟均肌注阿托品0.01mg/kg,苯巴比妥钠0.1g。GA+EA组患者先行硬膜外穿刺置管,1.5%利多卡因3ml试验量测定阻滞平面后更多还原

【Abstract】 Background and objectives Endotracheal intubation is essential tosecure the airway and to provide oxygenation for general anesthesia. However, endotracheal intubation is also a powerful noxious stimulus and the response may have deleterious effects on the respiratory, neurological, or cardiovascular system. It was evident that deeper levels of anesthesia are required to blunt the response to the stimulation of endotracheal tube (ETT) intubation than to suppress the pain from surgical incision. To anesthetize the trachea membrane with local anesthetics may make the deep anesthesia unnecessary and therefore reduce the general anesthetics requirement. The traditional methods of anesthetizing trachea membrane are either last too short time or have potential danger of local anesthetic toxication. This study used EMLA cream pre-coating ETT tube, a safe, effective long lastingmethod, to provide trachea membrane topical anesthesia and investigated whether the requirement of inhalational general anesthetics for general anesthesia or the combination of general and epidural anesthesia is reduced.Methods Sixty ASA I-II patients undergoing upper abdominal surgerieswere randomly assigned to 4 groups. Patients in group GA accepted general anesthesia without ETT pre-coated with EMLA cream. Patients in group GA+EMA also had general anesthesia but with ETT pre-coated with EMLA. Patients in group GA+EA accepted the combination of general and epidural anesthesia without ETT pre-coated with EMLA. Patients in group GA+EMA+EA had the combination of general and epidural anesthesia with ETT pre-coated with EMLA. All the patients in various groups were premedicated with sodium luminal and atropine. In group GA+EA and group GA+EMA+EA, epidural anesthesia were performed before the induction of general anesthesia. For the induction of anesthesia, midazolam 0.1 mg ■ kg"1, Fentanyl 4 p,g ■ kg"1, Propofol 1 mg ? kg"1 and vencuronium 0.1 mg ? kg"1 were administered. General anesthesia was maintained with inhale isoflurane and intravenous vecuronium. The inhalational concentration of isoflurance was adjusted according to the depth of anesthesia which was estimated by cardiovascular responses and the other signs. The end-tidal isoflurane concentrations were continuously recorded and the consumption of isoflurane were calculated by Equation: The consumption of isoflurane (ml)=fresh oxgen flow(l/min) X lOOOxthe isoflurane concentrations of vaporize X time(min)/196.Results To maintain a satisfactory anesthesia, the requirements ofisoflurance (expressed as MAC) were significantly different in each group (P=0.000). Group GA needed the highest isoflurane inhaled concentration (1.01+0.11MAC). Pre-coating ETT with EMLA decreased isoflurance inhaled concentration by 12% in general anaesthesia ( P=0.000 compared to general anesthesia alone). Epidural anesthesia reduced isoflurance requirement dramatically when it was combined with general anesthesia ( concentration dropped 38%, P=0.000). However, pre-coating ETT wih EMLA cream further decreased the need of isoflurane by 50% in epidural and general combined anesthesia (P=0.000 compared to general anesthesia alone). Group GA needed the largest volume of isoflurane consumed (12.9±1.8ml). Pre-coating ETT with EMLA decreased consumption of isoflurance by 13% in general anaesthesia ( P=0.002 compared to general anesthesia alone). Epidural anesthesia reduced consumption of isoflurance dramatically when it was combined with general anesthesia (dropped 48%, P=0.000). However, pre-coating ETT wih EMLA cream further decreased the consumption of isoflurane by 59% in epidural and general combined anesthesia (P= 0.000 compared to general anesthesia alone). There are the least incidence of side effects in GA+EMA+EA group (P=0.000) . There are not intraoperative awareness in all patients.Conclusion Pre-coating endotracheal tubes can successfully reduce theinhalational anesthetics need either in general anesthesia or the combination of general anesthesia and epidural anesthesia, and least incidence of sideeffects in postoperation . This simple technique is excellent to avoid unnecessary deep anesthesia and to save expensive general anesthetics.更多还原