全身麻醉结合硬膜外麻醉在腹部手术患者中的应用

Application of general anesthesia combined with epidural anesthesia in patients undergoing abdominal surgery

  • 摘要: 目的 分析腹部手术患者应用全身麻醉联合硬膜外麻醉的效果。 方法 选取300例行腹部手术的患者为研究对象,随机分为全身麻醉组(全身麻醉)和复合麻醉组(全身麻醉联合硬膜外麻醉),每组150例。观察并比较麻醉前及麻醉后12、24 h认知功能评分变化,麻醉药物诱导剂量及术中药物使用剂量,同时记录2组术后认知功能障碍(POCD)发生率。 结果 与全身麻醉组比较,复合麻醉组麻醉后12、24 h简易精神状况调查表(MMSE)评分较高,差异有统计学意义(P<0.05); 与全身麻醉组比较,复合麻醉组丙泊酚维持及诱导剂量、芬太尼维持及诱导剂量较少,差异均有统计学意义(P<0.05)。2组顺苯阿曲铵用量比较,差异无统计学意义(P>0.05)。与全身麻醉组比较,复合麻醉组清醒睁眼、准确完成指令、拔出管时间较短,差异有统计学意义(P<0.05)。复合麻醉组POCD发生率低于全身麻醉组,差异有统计学意义(P<0.05)。 结论 全身麻醉结合硬膜外麻醉能明显减少麻醉药物使用剂量,且对患者术后认知功能影响较小。

     

    Abstract: Objective To analyze the effect of general anesthesia combined with epidural anesthesia in patients with abdominal surgery. Methods A total of 300 patients with abdominal surgery were randomly divided into general anesthesia group(general anesthesia)and combined anesthesia group(general anesthesia combined with epidural anesthesia), with 150 cases in each group. The changes of cognitive function score before anesthesia, 12 and 24 h after anesthesia, induction dose of anesthetics and intraoperative dosage were observed and compared and the incidence of postoperative cognitive dysfunction(POCD)was recorded in the two groups. Results Compared with general anesthesia group, the Mini-mental State Examination(MMSE)scoresof combined anesthesia group were significantly higher at 12 and 24 h after anesthesia(P<0.05). Compared with the general anesthesia group, the maintenance and induction dosage of propofol and fentanyl in the combined anesthesia group were significantly less(P<0.05). There was no significant difference between the two groups in the amount of cisatracurium besylate(P>0.05). Compared with the general anesthesia group, the combined anesthesia group had shorter time of awake eye opening, accurate completion of instructions and pulling out tracheal extubation(P<0.05). The incidence of POCD in the combined anesthesia group was lower than that in the general anesthesia group, and the difference was statistically significant(P<0.05). Conclusion General anesthesia combined with epidural anesthesia can significantly reduce dosage of anesthetics and has little effect on postoperative cognitive function.

     

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