OPLAC喉罩通气全麻联合硬膜外阻滞用于高危患者麻醉的体会-现代医学

OPLAC喉罩通气全麻联合硬膜外阻滞用于高危患者麻醉的体会

单位：广东台山巿人民医院

分类号：

出版年·卷·期（页码）：2014·44·第六期（603-607）

摘要：

【摘要】目的探讨OPLAC喉罩通气全身麻醉联合连续硬膜外麻醉对高风险的老年患者下腹部及下肢手术的的影响。方法 50例高风险择期下腹部及下肢手术的老年患者，随机分成两组（n=25）：联合麻醉组（A组）;静脉麻醉组（B组）。A组患者分别给予硬膜外阻滞（0.33％罗哌卡因5毫升/小时，麻醉平面T10）联合OPLAC喉罩通气全身麻醉，诱导使用咪达唑仑（0.04mg•kg-1），芬太尼（2～6ug•kg-1），丙泊酚（1～1.5mg•kg-1）和阿曲库铵（0.1mg•kg-1），静脉维持丙泊酚（50～100ug•kg-1•min-1）和瑞芬太尼（0.05～0.5ug•kg-1•min-1）。B组患者实施OPLAC喉罩通气全身麻醉，诱导采用相同的药品和程序，静脉维持异丙酚（60～120 ug•kg-1•min-1）和瑞芬太尼（0.05～1ug•kg-1•min-1）。记录两组患者麻醉前（T0），诱导后（T1），喉罩插管（T2），喉罩插管后5分钟（T3），拔管（T4）时平均动脉压（MAP），心率（HR），脉搏血氧饱和度（SpO2）参数和麻醉药物用量，清醒时间，拔管时间，苏醒评分（Steward），以及术后恶心，呕吐并发症的发生率。结果与B组患者比较，A组患者清醒和拔管时间显著下降（P<0.05），苏醒评分（Steward）明显增加（P<0.05）。与B组相比，A组患者平均动脉压（MAP），心脏心率（HR），脉搏血氧饱和度（SpO2）血流动力学参数的稳定性显著升高（P<0.05），而麻醉药物用量和术后并发症的发生率明显下降（P<0.05）。结论OPLAC喉罩通气全身麻醉联合连续硬膜外泵注麻醉，减少麻醉药物剂量，意识和呼吸功能恢复更快，术后并发症的发生风险减少，更适合高危手术患者。

【Abstract】 Objective To investigate the effects of general anesthesia with OPLAC laryngeal mask Airway ventilation combined continuous epidural anesthesia for high-risk elderly patients in lower abdominal and lower limb surgery. Methods 50 patients were randomly divided into two groups(n= 25)：combined anesthesia group (Group A); intravenous anesthesia group (Group B). patients in group A were Administrated abdominal epidural block up to T10 induced with 0.33% Ropivacaine（5ml/h）; general anesthesia with OPLAC laryngeal mask airway were induced with Midazolam（0.04mg• kg-1）, Fentanyl（2～6ug• kg-1）, Propofol（1～1.5 mg•kg-1） and Atracurium（0.1 mg• kg-1） intravenously and maintained with Propofol （50～100 ug•kg-1•min-1）and Remifentanil（0.05～0.5ug•kg-1•min-1）, while patients in group B were induced the same drugs and procedures and maintained with Propofol （60～120 ug• kg-1•min-1）and Remifentanil（0.05～1ug• kg -1•min-1）. hemodynamic parameters of Mean arterial pressure (MAP), heart rate (HR)，pulse oxygen saturation (SpO2) at time of before induction (T0), after induction (T1), intubation (T2), 5 mins after intubation (T3)， extubation (T4)；Anesthetic drug dosage，awake time，extubation time， recovery Scale（Steward），and incidence of postoperative complications such as Nausea, vomiting were recoded. Results Compared with group B, the time of awake and extubation in group A were significantly decreased (P<0.05), and recovery Scale were significantly increased (P<0.05). Compared with group B, the stability of hemodynamic parameters of Mean arterial pressure (MAP), heart rate (HR)，pulse oxygen saturation (SpO2) in group A were significantly increased (P<0.05), while Anesthetic drug dosage significantly decreased (P<0.05). Compared with group B, the incidence of postoperative complications in group A were significantly decreased (P<0.05). Conclusions general anesthesia combined c

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