目的 研究全麻(general anesthesia,GA)复合胸段硬膜外阻滞(thoracic epidural anesthesia,TEA)对术中输注氨基酸患者氧耗量(oxygen consumption,VO2)的影响.方法 选择30例ASA Ⅰ～Ⅱ级、择期行中上腹部手术的患者,随机分为单纯全麻组(GA组,n=15)和全麻复合TEA组(GAE组,n=15).入室后行胸段硬膜外穿刺置管、颈内静脉及桡动脉穿刺置管,诱导气管插管后采用Driger Zeus麻醉工作站行Auto-control模式机械通气并监测实时VO2,术中七氟醚最低流量紧闭麻醉复合异丙酚、瑞芬太尼输注,根据手术需要间断追加罗库溴铵和芬太尼.两组诱导同时输注18氨基酸注射液4kJ·kg-1·h-1,持续2h或手术结束时(手术未满2h).GAE组在切皮前分3次给予0.375％布比卡因共10 mL作为负荷量,此后追加4 mL/h,直至手术结束.GA组在相同时间点给予等容积的生理盐水.记录气管插管前5(-5)rnin和插管后0、5、15、30、45、60、75 min的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)值和插管后5、15、30、45、60、75 min的VO2和鼻咽温度(Tcore)值.记录术中麻醉药和升压药用量情况.结果 随着输注时间延长,两组VO2均稍上升但差异无统计学意义(P＞0.05),且GAE组稍高于GA组,但组间差异无统计学意义(P＞0.05)；气管插管后30 min后,两组Tcore显著下降并趋于稳定(P＜0.05),但组间差异无统计学意义(P＞0.05)；与GA组相比,GAE组的芬太尼用量(P＜0.01)和瑞芬太尼用量(P＜0.01)更少,但去氧肾上腺素用量(P＜0.01)和麻黄碱用量(P＜0.05)更多.结论 与单纯GA相比,GA复合TEA尽管能显著减少患者术中输注氨基酸患者的芬太尼和瑞芬太尼的用量,但并不能降低其VO2.%Objective To investigate the effect of general anesthesia(GA)combined with thoracic epidural anesthesia(TEA)on oxygen consumption(VO2)of patients received intraoperatively intravenous administration of amino acid.Methods Thirty patients,ASA physical status Ⅰ-Ⅱ,undergoing middle-upper abdominal surgery randomly received either GA combined with TEA(GAE group,n =15)or GA only(GA group,n =15).For all patients in the operation room(OR),an epidural catheter was inserted at a tharacic level between T8 and T9,and a catheter was inserted into the right internal jugular vein and another into the left radial artery.Patients' lungs were ventilated with Autocontrol model by Drager Zeus anesthesia workstation,by which the real-time VO2 was also monitored.Anesthesia was maintained with closed-circuit sevoflurane combined with intravenous propofol and remifentanil.Supplemental doses of rocuronium and fentanyl were applied as needed.An infusion of compound amino acid 11.4％ solution was started at a rate of 4 kJ · kg-1 · h-1 simultaneously and continued for 2 h or until the end of surgery(if surgery time less than 2 h)in both groups.In GAE group,total 10 mL of 0.375％ epidural bupivacaine was administered for loading dose before skin incision,and intermittently supplemental bolus dose of 4 mL of 0.375 ％ bupivacaine was given every hour,whereas the equal volume of epidural saline was given at each corresponding time points in GA group.Mean arterial pressure(MAP)and heart rate(HR)were recorded 5 min before and 0,5,15,30,45,60 and 75 min after tracheal intubation,as well as VO2 and Tcore 5,15,30,45,60,75 min after the intubation.The requirement of anesthetics(including propofol,fentanyl,remifentanil and rocuronium)and vasopressor(phenylephrine and ephedrine)were recorded,respectively.Results Compared to the basic value of VO2 at 5 min,VO2 at 15,30,45,60 and 75 min increased slightly in both groups but no significant difference was found(P＞ 0.05),and no significant difference at all time points was found between the two groups(P＞0.05).Tcores in both groups decreased significantly since 30 min(P＜0.05),and no significant difference existed between the two groups(P＞0.05).Compared to GA group,requirements of fentanyl(P ＜ 0.01)and remifentanil(P ＜ 0.01)were significantly reduced and the requirements of phenylephrine(P＜0.01)and ephedrine(P＜0.05)significantly increased in GAE group.Conclusions Compared with GA,GA combined with TEA significantly reduces the does of fentanyl and remifentanil in patients received intravenously administrated of amino acid during the operation,but it has no effect on VO2.
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