硬膜外復(fù)合全麻與硬膜外鎮(zhèn)痛-文庫吧資料
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【正文】 blockade in knee arthroplasty. Acta Orthop Scand. 1990 Feb。Hara PJ, Krajewski LP, Sullivan TM, Beven EG. Epidural versus general anesthesia: does anesthetic management influence early infrainguinal graft thrombosis? Ann Vasc Surg. 1998 Jan。73(6):696704. ? 麻醉不是一個(gè)因素 (GA vs EA) 1. Pierce ET, Pomposelli FB Jr, Stanley GD, Lewis KP, Cass JL, LoGerfo FW, Gibbons GW, Campbell DR, Freeman DV, Halpern EF, Bode RH Jr. Anesthesia type does not influence early graft patency or limb salvage rates of lower extremity arterial bypass. J Vasc Surg. 1997 Feb。93(4):8538. 硬膜外鎮(zhèn)痛更好 血栓栓塞 ?硬膜外的優(yōu)勢(shì) ? 交感阻滯 ?血管舒張 ? 下肢血流更好、減少凝血傾向和保護(hù)纖溶功能 ? 局麻藥有抑制血小板聚集和穩(wěn)定白細(xì)胞與血管內(nèi)皮細(xì)胞的功能 硬膜外鎮(zhèn)痛更好 移植血管的通暢 ? 硬膜外好 1. Perler BA, Christopherson R, Rosenfeld BA, Norris EJ, Frank S, Beattie C, Williams GM. The influence of anesthetic method on infrainguinal bypass graft patency: a closer look. Am Surg. 1995 Sep。43(8):76977. ? 無差別 1. Bois S, Couture P, Boudreault D, Labe P, Fugere F, Girard D, Nadeau N. Epidural analgesia and intravenous patientcontrolled analgesia result in similar rates of postoperative myocardial ischemia after aortic surgery. Anesth Analg. 1997 Dec。V 住院日 硬膜外好 1,2,3,4,5,6,7,8,9,10,12,13, 14,15,16,17, 18,19,20,21, 22,26,29,31,34, 37 (26) 2,3,11,14, 17,24,28 (7) 16,18, 26,27 (4) 2,10,12, 18,19,20 ,28 (7) (0) 3,6,16, 20,31 (5) 11,26,31 (3) 硬膜外 = PCA 23,24,26,28,30,32,33,35,36,38 (10) 13,34 (2) 10,28 (2) 38 (1) 13,23,33 (3) 5,12,13, 25,28,38 (6) 17,23,33, 34 (4) 硬膜外差 (0) (0) (0) (0) (0) (0) (0) 心血管并發(fā)癥的比較 ?硬膜外的優(yōu)勢(shì) ?胸部硬膜外阻滯心交感纖維減慢心率 ?更好的疼痛控制減少心臟的應(yīng)激 硬膜外鎮(zhèn)痛更好 心血管并發(fā)癥的比較 ? 硬膜外好 1. de LeonCasasola OA, Lema MJ, Karabella D, Harrison P. Postoperative myocardial ischemia: epidural versus intravenous patientcontrolled analgesia. A pilot project. Reg Anesth. 1995 MarApr。74:6267 結(jié)論 : CEGA與 GA組比術(shù)中失血與輸血均少 ,PCA需求更少但 VAS評(píng)分更低 硬膜外復(fù)合全麻優(yōu)勢(shì)與特點(diǎn) ?40篇有關(guān)硬膜外復(fù)合全麻的論文薈萃分析 (國(guó)內(nèi) ) ?普外、胸外、高齡和小兒外科手術(shù) ?減少麻醉藥的量 ?抑制應(yīng)激 ?血流動(dòng)力學(xué)波動(dòng) ?提高清醒質(zhì)量 ?改善術(shù)后鎮(zhèn)痛 ?減少術(shù)后惡心嘔吐 硬膜外復(fù)合全麻好 硬膜外復(fù)合全麻 3, 4, 6, 8, 9, 15, 19 ,20, 22, 23, 24 ,27 ,28, 29, 31 ,32 ,33 ,34 ,39 (19) 1, 2, 5, 7, 10, 12, 16, 17, 23, 25, 30, 35, 36, 37, 40 (15) 2, 3, 6, 8, 9, 11, 13, 14, 18, 19, 20, 21, 23, 27, 31, 32, 37, 39 (18) 3, 6, 8, 9, 11, 19, 20, 23, 24, 27, 29, 32, 39 (13) 3, 4, 8, 11, 19, 20, 24, 31, 34, 39 (10) 6, 9, 15, 23, 27, 29, 32, 17 (8) 硬膜外復(fù)合全麻之優(yōu)點(diǎn)： ? ? ? ? ? 硬膜外復(fù)合全麻之缺點(diǎn)： ?血流動(dòng)力學(xué)波動(dòng) ?為高容性血液稀釋創(chuàng)造了條件 結(jié)論 硬膜外復(fù)合全麻好 硬膜外鎮(zhèn)痛更好 術(shù)后鎮(zhèn)痛的目的 減輕疼痛 降低死亡率 盡早出院 幫助快速恢復(fù) 改善生活質(zhì)量 改善術(shù)后臨床轉(zhuǎn)歸 硬膜外鎮(zhèn)痛更好 疼痛管理中藥物選擇 nists PCA用于術(shù)后鎮(zhèn)痛 – 系統(tǒng)綜述 ? 不良反應(yīng) . PCA對(duì)照組 呼吸遲緩 (RR10/min) % (332) % % (367) 低氧血癥 (SaO2 90%) %(92) % (88) 惡心 % (252) % (253) 嘔吐 % (83) %(83) 惡心和 /或嘔吐 % (440) %(450) 鎮(zhèn)靜 %(261) % (258)
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