Turfrey D J, Ray D A, Sutcliffe N P, Ramayya P, Kenny G N, Scott N B
HCI International Medical Centre, Clydebank, Glasgow, UK.
Anaesthesia. 1997 Nov;52(11):1090-5. doi: 10.1111/j.1365-2044.1997.260-az0397.x.
We have performed a retrospective analysis of the peri-operative course of 218 consecutive patients who underwent routine coronary artery bypass graft surgery in this institution. All patients received a standardised general anaesthetic using target-controlled infusions of alfentanil and propofol. One hundred patients also received thoracic epidural anaesthesia with bupivacaine and clonidine, started before surgery and continued for 5 days after surgery. The remaining 118 patients received target-controlled infusion of alfentanil for analgesia for the first 24 h after surgery, followed by intravenous patient-controlled morphine analgesia for a further 48 h. Using computerised patient medical records, we analysed the frequency of respiratory, neurological, renal, gastrointestinal, haematological and cardiovascular complications in these two groups. New arrhythmias requiring treatment occurred in 18% of the thoracic epidural anaesthesia group of patients compared with 32% of the general anaesthesia group (p = 0.02). There was also a trend towards a reduced incidence of respiratory complications in the thoracic epidural anaesthesia group. The time to tracheal extubation was decreased in the epidural group, with the tracheas of 21% of the patients being extubated immediately after surgery compared with 2% in the general anaesthesia group (p < 0.001). There were no serious neurological problems resulting from the use of thoracic epidural analgesia.
我们对在本机构接受常规冠状动脉旁路移植手术的218例连续患者的围手术期过程进行了回顾性分析。所有患者均使用阿芬太尼和丙泊酚靶控输注进行标准化全身麻醉。100例患者还接受了布比卡因和可乐定的胸段硬膜外麻醉，术前开始并在术后持续5天。其余118例患者术后前24小时接受阿芬太尼靶控输注镇痛，随后再接受48小时静脉自控吗啡镇痛。我们利用计算机化的患者病历，分析了这两组患者呼吸、神经、肾脏、胃肠道、血液学和心血管并发症的发生频率。需要治疗的新发心律失常在胸段硬膜外麻醉组患者中的发生率为18%，而全身麻醉组为32%（p = 0.02）。胸段硬膜外麻醉组呼吸并发症的发生率也有降低的趋势。硬膜外组气管拔管时间缩短，21%的患者术后立即拔管，而全身麻醉组为2%（p < 0.001）。使用胸段硬膜外镇痛未导致严重的神经问题。
