李庆学　尹震

【摘要】 目的：探讨全身麻醉复合硬膜外麻醉（GEA）在肺部手术中的临床应用价值及安全性。方法：选取2011年1月-2015年9月于本院择期行肺叶或肺叶部分切除手术的60例肺癌患者按照随机数字表法分为GEA组和单纯全麻（GA）组，每组各30例。分别记录每组患者全麻诱导前5 min、切皮前3 min、切皮时、停全麻药时、停全麻药15 min及苏醒拔管时的血压（BP）、心率（HR）及经皮氧饱和度（SpO2），并统计患者术中吸入麻醉药和肌肉松弛剂的剂量及术后肺部感染发生率。术后镇痛方法：GEA组用PCEA泵，GA组术后肌注杜非合剂。结果：两组患者的手术时间、出血量比较差异均无统计学意义（P>0.05），在全麻诱导前5 min、切皮前3 min、停用全麻药时的BP、HR及SpO2各项指标比较差异均无统计学意义（P>0.05），GEA组围术期的血压、心率平稳，患者安静舒适，呼吸均匀，经皮氧饱和度优，术后恢复期刀口无痛，未发生肺部并发症。GEA组的BP、HR及SpO2指标均明显优于GA组，差异均有统计学意义（P<0.05或P<0.01）。结论：GEA应用于胸科手术并配合PCEA泵的使用具有重要的临床意义，是肺癌患者行肺叶或肺叶部分切除术较为理想的麻醉方法。

【关键词】 全身麻醉； 硬膜外麻醉； 肺癌； 肺叶部分切除

Clinical Application of General Anesthesia Combined with Epidural Anesthesia in the Treatment of Lung Cancer Patients with Lobectomy or Partial Resection of Lung/LI Qing-xue，YIN Zhen.//Medical Innovation of China，2016，13（09）：138-141

【Abstract】 Objective：To investigate the clinical application value and safety of general anesthesia combined with epidural anesthesia（GEA） in the pulmonary surgery.Method：Sixty patients with lung cancer who underwent lobectomy or partial resection of lung in our hospital from January 2011 to September 2015 were divided into the GEA group and the general anesthesia（GA） group according to the random number table，30 cases in each group.The blood pressure（BP），heart rate（HR） and percutaneous oxygen saturation（SpO2） values were recorded at 5 minutes before general anesthesia inducing，3 minutes before skin incision，at skin incision，the moment to stop general anesthetics，15 minutes after stop general anesthetics and the state of palinesthesia and pulling out the tube，the dose of inhalation anesthetics，muscle relaxant and the incidence of postoperative pulmonary infection were counted as well.Postoperative analgesia method of GEA group was PCEA pump，while the patients of GA group were given intramuscular injection of Dolantin and Promethazine.Result：Patients of the two groups had no significant differences in the terms of the operation time and bleeding volume（P>0.05），there were no statistically significant differences in the BP，HR and SpO2 between the two groups at 5 minutes before general anesthesia inducing，3 minutes before skin incision and the moment to stop general anesthetics（P>0.05）.The perioperative blood pressure and heart rate of GEA group kept stable，patients were quiet and comfortable，breathing evenly with transcutaneous oxygen saturation，in the postoperative recovery period，the patients had no pain caused by the operation or any pulmonary complications，the indicators of BP，HR and SpO2 in the GEA group were significantly better than those in the GA group，there were significant differences between the two groups（P<0.05 or P<0.01）.Conclusion：The application of GEA in thoracic surgery with PCEA pump has especial clinical significance，it is an ideal anesthesia method for lobectomy or lung resection surgery on patients with lung cancer.

【Key words】 General anesthesia； Epidural anesthesia； Lung cancer； Partial resection of lung

First-authors address：Caoxian Traditional Chinese Medicine Hospital of Shandong Province，Caoxian 274400，China

doi：10.3969/j.issn.1674-4985.2016.09.040

肺癌是发病率和死亡率增长最快、对人群健康和生命威胁最大的恶性肿瘤之一，外科手术治疗是肺癌首选和最主要的治疗方法，也是唯一能使肺癌治愈的治疗方法[1]。但机体对手术创伤和术后刀口疼痛常常以应激反应方式来维持一种自稳状态，临床上往往表现为血压升高、心率增快、患者烦躁不安等。而这些应激反应一方面有利于机体恢复，但另一方面也有负面影响，甚至会使患者发生严重意外，因此良好的麻醉支持是手术治疗成功和患者术后恢复的关键[2]。本研究的……