- 期刊
Thoracic Epidural Anesthesia for Major Abdominal Surgery: A Retrospective Study
胸椎硬脊膜外麻醉於腹部大手術之運用
摘要
In 1986-1988, the authors had experiences with thoracic epidural anesthesia for a variety of major abdominal operations in 303 patients. It is proved to be reliable and effective. The puncture levels were between T8 to T12.2% lidocaine, in plain form or with 1:200,000 epinephrine, was used as anesthetic agent. Perioperative complications were carefully managed with satisfactory results. Post-operative conditions were evaluated and seemed to be superior to those of general anesthesia in many aspects. No patient had neurologic deficit as a result of the epidural anesthesia. We concluded that thoracic epidural anesthesia is an excellent alternative technique in major abdominal surgeries.
並列摘要
一般腹部大手術都選擇全身麻醉，其優點在可確保良好呼吸與肌肉鬆弛，利於手術，但隨著患者年齡層的上升，以及原本伴有肺部疾病者的增多，使得術後肺併發症的增加成爲新的難題。硬脊膜外麻醉對患者術後結果的良好影響，近年來有頗多報導，唯以胸椎硬脊膜外麻醉進行腹部大手術則較少，主要是它面臨維持充足換氣不易與肌肉鬆弛度不足的兩難。而有限的報告中又多併用氣管插管與淺度全身麻醉，僅以胸椎硬脊膜外麻醉爲之者較少。我們在兩年中對303例接受腹部大手術患者施以胸椎硬脊膜外麻醉。穿刺部位在T8至T12之間，選擇2% lidocaine作爲局部麻醉劑。其中70位患者並接受硬脊膜外給與2.5－3.0毫克嗎啡，作爲術後止痛之用。303例皆成功完成胸椎硬脊膜外導管放置，没有任何血管內或蛛網膜下注射的情形發生。290例使用不添加epinephrine之2% lidocaine，另13例則使用添加1：200,000 epinephrine之2% lidocaine。由於兩組病人人數相差懸殊，故無法比較添加epinephrine於局部麻醉劑中，對於延長局部麻醉劑之作用時間，及對交感神經阻斷引起血壓下降之發生率是否造成顯著影響。手術中發生心搏減慢，焦慮不安等狀況，皆獲得有效改善。有6個病人在手術中因麻醉部位過高，致換氣量不足，而必須予以氣管插管及使用呼吸器輔助換氣。其餘病人皆可保持足夠之呼吸機能，動脈血氣體分析顯示氧分壓及二氧化碳分壓在正常範圍內。多數接受胸椎硬膜外麻醉之患者，皆能達到良好之麻醉效果及提供足夠肌肉鬆弛度。手術後之恢復情況及合併症的評估，也都令人滿意。對此303個病例之回溯性研究，結果顯示胸椎硬脊膜外麻醉爲一適用於腹部大手術，且具安全性之麻醉方式。惟麻醉當中對患者呼吸道暢通，呼吸功能及其他生命徵象之監測與維持，應謹慎爲之。