本文選題：利多卡因 + 硬膜外阻滯　； 參考：《中國藥房》2017年12期

【摘要】：目的:探討利多卡因硬膜外阻滯復(fù)合全麻對(duì)肺癌患者術(shù)后相關(guān)指標(biāo)的影響。方法:回顧性分析108例行手術(shù)治療的肺癌患者資料,按麻醉方式的不同分為觀察組(56例)和對(duì)照組(52例)。兩組患者均靜脈滴注異丙酚注射液和芬太尼注射液的復(fù)合液,并輔助吸入1%吸入用七氟醚輔助麻醉,間斷靜脈滴注注射用維庫溴銨維持肌松。在此基礎(chǔ)上,觀察組患者硬膜外輸注2.0%鹽酸利多卡因注射液5 m L/h維持麻醉;對(duì)照組患者硬膜外輸注0.9%氯化鈉注射液5 m L/h維持麻醉。觀察兩組患者麻醉時(shí)間、手術(shù)時(shí)間、術(shù)中出血量、術(shù)后蘇醒時(shí)間,芬太尼、異丙酚、維庫溴銨、七氟醚使用量,術(shù)后麻醉相關(guān)并發(fā)癥(惡心、嘔吐、頭暈、嗜睡、皮膚瘙癢)及其他并發(fā)癥(心功能不全、心血管事件、房顫、感染、短暫性腦缺血、急性冠狀動(dòng)脈綜合征、腦卒中)發(fā)生情況,術(shù)后4 h及1、2、3、4、5 d的活動(dòng)與平靜時(shí)疼痛視覺模擬(VAS)評(píng)分。結(jié)果:觀察組患者麻醉時(shí)間、手術(shù)時(shí)間、術(shù)中出血量、術(shù)后蘇醒時(shí)間,芬太尼、異丙酚、七氟醚使用量,術(shù)后4 h、1、2 d平靜時(shí)的VAS評(píng)分及術(shù)后4 h、1、2、3 d活動(dòng)時(shí)的VAS評(píng)分、嗜睡發(fā)生率均顯著短于或低于對(duì)照組,頭暈發(fā)生率顯著高于對(duì)照組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);兩組患者維庫溴銨使用量,其他時(shí)間平靜與活動(dòng)時(shí)的VAS評(píng)分,惡心、嘔吐、皮膚瘙癢、心功能不全、心血管事件、房顫、感染、短暫性腦缺血、急性冠脈綜合征及腦卒中發(fā)生率比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:利多卡因硬膜外阻滯復(fù)合全麻可減少肺癌患者術(shù)中出血量,降低術(shù)后疼痛程度,縮短術(shù)后蘇醒時(shí)間,且未增加術(shù)后并發(fā)癥的發(fā)生。
[Abstract]:Objective: to investigate the effect of lidocaine epidural block combined with general anesthesia on postoperative indexes in patients with lung cancer.Methods: the data of 108 patients with lung cancer treated by operation were analyzed retrospectively. According to the different anesthetic methods, the patients were divided into observation group (n = 56) and control group (n = 52).In both groups, propofol and fentanyl injection were injected intravenously with 1% inhaled sevoflurane as adjuvant anesthesia, and vecuronium for intermittent intravenous injection was used to maintain muscle relaxation.On this basis, epidural infusion of 2.0% lidocaine hydrochloride injection 5 mL / h was maintained in the observation group and 0.9% sodium chloride injection 5 mL / h was maintained in the control group.Anaesthesia time, operation time, intraoperative bleeding, postoperative recovery time, fentanyl, propofol, vecuronium, sevoflurane usage, postoperative anaesthesia related complications (nausea, vomiting, dizziness, lethargy) were observed.Skin itching) and other complications (cardiac insufficiency, cardiovascular events, atrial fibrillation, infection, transient cerebral ischemia, acute coronary syndrome, stroke),The activity and visual analogue of pain were assessed at 4 hours and 1 hour and 3 minutes and 4 days after operation.Results: in the observation group, the anesthetic time, operative time, intraoperative bleeding volume, postoperative recovery time, fentanyl, propofol, sevoflurane usage, VAS score at 1 / 2 day after operation and VAS score at 4 h / 12 ~ 2d activity were observed in the observation group.There was no significant difference in the incidence of pruritus, cardiac insufficiency, cardiovascular events, atrial fibrillation, infection, transient cerebral ischemia, acute coronary syndrome and stroke.Conclusion: Lidocaine epidural block combined with general anesthesia can reduce the amount of intraoperative bleeding, reduce the degree of postoperative pain, shorten the time of postoperative recovery, and not increase the incidence of postoperative complications in patients with lung cancer.
【作者單位】： 海南省農(nóng)墾總醫(yī)院麻醉科;
【分類號(hào)】：R614;R734.2

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