不同的麻醉方式在晚期血吸虫病患者实施近端脾肾分流术的麻醉效果对比

摘要

目的 研究不同麻醉方式对晚期血吸虫病患者实施近端脾肾分流术的麻醉效果.方法 临床纳入106例本院2013年4月至2015年4月期间收治的晚期血吸虫病患者,所有患者均行脾肾分流术进行治疗.按随机数字表法将患者分为两组,各53例.其中53例患者术中采用单纯全身麻醉作为对照组,另53例患者术中采用全麻复合硬膜外阻滞麻醉作为观察组,观察两组患者的麻醉效果、不良反应以及转氨酶水平变化情况.结果 观察组七氟醚维持浓度、术后睁眼时间以及拔管时间分别为(0.9±0.4)％、(2.4±1.1) min、(7.2±2.5) min,均优于对照组的(1.6±0.5)％、(5.3±1.8) min、(11.9±4.6)min,t=7.959、10.008、6.536,P＜ 0.05.术前观察组ALT、AST水平为(38.2±11.6)U/L、(41.3±14.6)U/L,对照组为(38.5±12.3)U/L、(40.7±14.2)U/L,两组差异无统计学意义(t=0.129、0.214,P＞0.05);术后观察组ALT、AST水平分别为(50.4±15.1) U/L、(51.6±15.2) U/L,明显低于对照组的(71.2±21.4)U/L、(65.7±23.1)U/L,t=5.782、3.712,P＜ 0.05.对照组、观察组不良反应发生率分别为13.21％、3.77％,观察组明显较低(x2=5.735,P＜0.05).结论 全麻复合硬膜外阻滞麻醉可有效保障晚期血吸虫病患者脾肾分流术的安全性,提高麻醉效果,保护肝功能,值得临床应用及推广.%Objective To study the clinical effect of different anesthesia methods for proximal splenorenal shunt in patients with advanced schistosomiasis.Methods 106 patients with advanced schistosomiasis treated at our hospital from April,2013 to April,2015 were selected.All the patients received spleno-renal shunt.The subjects were randomly divided into two groups,53 cases for each group.The control group took general anesthesia and the observation group general anesthesia combined with epidural anesthesia.The anesthesia effect,adverse reactions,and level of aminopherase was observed in both groups.Results The maintenance concentration of sevoflurane,time of opening eyes,and extubation time were better in the observation group than in the control group (P＜0.05).There were no statistical differences in the levels of ALT and AST between these two groups before the treatment(P＞0.05);after the treatment,the levels of ALT and AST were significantly lower in the observation group than in control group (P＜0.05).the incidence of adverse reactions was 3.77％ in the observation group and was 13.21％ in the control group (P＜0.05).Conclusions General anesthesia combined with epidural anesthesia can efficiently guarantee the safety of spleno-renal shunt for patients with advanced schistosomiasis,improve anesthesia effect,and protect liver function.It is worth being clinically generalized.