【作者】 康伟；

【导师】 郑宏；

【作者基本信息】 新疆医科大学 ， 麻醉学， 2007， 硕士

【摘要】 目的:观察和分析异位妊娠手术中能够预测血压波动的因素,比较全身麻醉与硬膜外麻醉用于异位妊娠手术对循环系统的影响和效价比,提出合理的麻醉选择流程。方法:将新疆医科大学第一附属医院2005-2006年间242例异位妊娠手术患者资料纳入回顾性分析,观察到麻醉记录单中最常见的不良反应是手术中血压的波动。第一步对可能造成血压波动的因素进行了筛选,利用Logistic多元回归技术进行逐步回归,建立回归方程。第二步用配对分组的原则选择了72例患者的资料,对比了两种麻醉方法对循环的影响。全身麻醉患者36例:咪唑安定0.15-0.2mg/kg、芬太尼0.1-0.2mg、维库溴胺0.1mg/kg行静脉麻醉诱导,持续静脉泵入丙泊酚4-6mg/kg·h、间断静脉注射芬太尼0.1-0.2mg及维库溴铵0.05mg/kg维持麻醉;硬膜外麻醉患者36例:穿刺点选择L_1-2或L_2-3间隙,试验剂量为2%利多卡因4-5ml,麻醉平面确切后硬膜外注入1%罗派卡因8-10ml,2.5小时后追加4-5ml。对2组患者术中血压波动的发生率、麻醉时间、麻醉费用进行观察比较。综合上述结果,提出此类手术麻醉选择的基本原则。结果:经回归分析,能够预测异位妊娠手术中血压波动的因素有术前休克指数、平均动脉压和不同麻醉方法等三个因素。接下来的对比分析得到的结果是:全身麻醉组共有5例（13.9%）患者发生了血压波动,连续硬膜外麻醉为15例（41.7%）,2组间差异有统计学意义（P=0.009）。全身麻醉和硬膜外麻醉组的麻醉费用、药费、总费用分别为:897.6±67.1、414.4±122.7、1312.1±160.3和438.3±46.5、269.7±91.4、708.0±112.0元,两组间差异有统计学意义（P＜0.001）。全身麻醉组和硬膜外麻醉组的麻醉时间中位数、众数分别为为2.5h、2h和2h、2h,2组患者麻醉时间无统计学差异（P＜0.05）。结论:可以通过休克指数、平均动脉压和不同麻醉方法等因素预测异位妊娠手术中发生血压波动的可能性。根据术前休克的严重程度（主要由休克指数和平均动脉压体现）来决定麻醉方法,根据指南选择有创监测并进行积极的液体复苏。同一异位妊娠患者,应全身麻醉术时,血流动力学稳定,镇痛效果好,但费用明显高于连续硬膜外麻醉。更多还原

【Abstract】 Objective:To observe and analyze the factors which can predict the probability of blood pressure disturbances in ectopic pregnancy operations and compare the differences of the cost-effects as well as effects on circulation using two different anesthesia techniques. Methods:One hundred and ninety-two patients in First Affiliation Hospital of Xinjiang Medical University were enrolled in the retrospective study. In a preliminary study ,a logistic model was developed to evaluate predictors of intraoperative blood disturbances. Next, Seventy-two patients undergone ectopic pregnancy operations were studied. Thirty-six patients in general anesthesia group performed with midazolam 0.15-0.2mg/kg、fentanyl 0.1-0.2 mg、vecuronium 0.1 mg/kg for induction followed by propofol infusion at the rate of 4-6 mg/kg·h and intermittent fentanyl 0.1-0.2 mg and vecuronium 0.05 mg/kg injection for maintenance. Thirty-six patients in epidural anesthesia group received 2% lidocaine 4-5 ml to inspect the effect of anesthesia then were injected with 1% ropivacine 8-10 ml and added with 4-5 ml after 2.5 hours. Hemodynamic disturbances、anesthesia times and direct costs in the two groups were observed and analyzed. Finally, a strategy was developed to help anesthetists to select reasonable method. Results: Preoperative factors, such as shock index, mean arterial pressure and different anesthesia method can predict the incidence of blood pressure disturbance in in ectopic pregnancy operations. Compared with general anesthesia group in which five patients (13.9%) suffered with blood pressure disturbances, the frequency of blood pressure disturbance in epidural anesthesia was 41.7% (15 cases). The differences were significant(P=0.009).The anesthesia costs、drugs costs、total costs in general anesthesia group and epidural anesthesia group were 897.6±67.1、414.4±122.7、1312.1±160.3 and 438.3±46.5、269.7±91.4、708.0±112.0 yuan(P<0.001), the differences were statistically significant. The median and mode of anesthesia time in general anesthesia group and epidural anesthesia group were 2.5h、2h and 2h、2h.there is no significant between them. Conclusions:Shock index, mean arterial pressure and different anesthesia method can predict the incidence of blood pressure disturbance in in ectopic pregnancy operations. Hemodynamic status may be more stable, effects of analgesia may be better in general anesthesia group compared with epidural anesthesia group. Total costs in general anesthesia group was higher than epidural anesthesia group.更多还原