Porizka Michal, Koudelkova Katerina, Kopecky Petr, Porizkova Hana, Dohnalova Alena, Kunstyr Jan
Department of Anaesthesiology, Resuscitation and Intensive Medicine, First Faculty of Medicine, General University Hospital, Charles University in Prague, U Nemocnice 2, 128 08 Prague 2, Czech Republic.
Institute of Physiology, First Faculty of Medicine, Charles University in Prague, Albertov 5, Prague 2, 128 00 Czech Republic.
Springerplus. 2016 Jun 21;5(1):799. doi: 10.1186/s40064-016-2541-6. eCollection 2016.
Thoracic epidural anesthesia (TEA) has been proposed to improve and facilitate early postoperative outcome in cardiac surgery. The aim of our study was to analyze early postoperative outcome data of patients undergoing cardiac surgery under general anesthesia (GA) with comparison to patients receiving combined TEA and GA.
Medical records data from 288 patients who underwent elective on-pump cardiac surgery were retrieved and analyzed. Patients were divided into two study groups according to the type of anesthesia used: GA group (n = 141) and TEA group (n = 147). Early postoperative outcome data including quality of analgesia and major organ outcome parameters were compared between the study groups.
There was no major difference in early postoperative outcome data between the study groups, except for shorter time to extubation (6.0 ± 10.0 vs. 6.9 ± 8.8 h, respectively, P < 0.05) and hospital stay (10.7 ± 5.9 vs. 12.9 ± 8.8 days, respectively, P < 0.05) in TEA group compared to GA group. Also TEA group as compared to GA group had lower pain numeric rating scale scores (1 ± 1.1 vs. 1.4 ± 1.5 at 24 h, respectively, P < 0.05) and morphine requirements during the first 24 h after surgery (148.2 vs. 193 ± 85.4 μg/kg, respectively, P < 0.05).
Both anesthetic methods were equivalent in most postoperative outcome measures. Thoracic epidural analgesia provided superior pain relief, shorter time to extubation and earlier hospital discharge.
有人提出胸段硬膜外麻醉（TEA）可改善并促进心脏手术术后早期恢复。我们研究的目的是分析在全身麻醉（GA）下行心脏手术患者的术后早期恢复数据，并与接受TEA联合GA的患者进行比较。
检索并分析了288例行择期体外循环心脏手术患者的病历资料。根据麻醉方式将患者分为两个研究组：GA组（n = 141）和TEA组（n = 147）。比较研究组之间术后早期恢复数据，包括镇痛质量和主要器官恢复参数。
研究组之间术后早期恢复数据无显著差异，但TEA组与GA组相比，拔管时间更短（分别为6.0±10.0小时和6.9±8.8小时，P<0.05），住院时间更短（分别为10.7±5.9天和12.9±8.8天，P<0.05）。此外，TEA组与GA组相比，术后24小时疼痛数字评分量表得分更低（分别为1±1.1和1.4±1.5，P<0.05），术后前24小时吗啡需求量更低（分别为148.2和193±85.4μg/kg，P<0.05）。
两种麻醉方法在大多数术后恢复指标上相当。胸段硬膜外镇痛提供了更好的疼痛缓解、更短的拔管时间和更早的出院时间。
