【罂粟摘要】硬膜外麻醉复合全身麻醉与单纯全身麻醉在新生儿胃肠道手术中的效果比较：一项随机对照试验
硬膜外麻醉复合全身麻醉与单纯全身麻醉在新生儿胃肠道手术中的效果比较：一项随机对照试验
贵州医科大学 麻醉与心脏电生理课题组
翻译：马艳燕 编辑：潘志军 审校：曹莹
背景
术后肠梗阻是在全身麻醉下行胃肠道手术的常见并发症。本研究的目的是研究在行择期胃肠道手术的新生儿中，胃肠道功能的快速恢复是否与硬膜外麻醉联合全身麻醉有关。
方法
一项随机对照试验，包括60名在大学附属医院行胃肠道手术的新生儿。30例新生儿接受硬膜外麻醉复合全身麻醉(CEGA)，另外30例新生儿单独行全身麻醉(GA)。主要结局指标是术后接受全肠内营养的时间。次要结局指标是术后通便时间、鼻胃管引流时间和感染时间。
结果
排除了2名在硬膜外置管时反复尝试均未成功的CEGA组的新生儿后，共有58名新生儿完成了研究(CEGA：28；GA：30)。CEGA组比GA组更早耐受全肠内营养(4.0天 vs 8.0天；P=0.0001)。CEGA组的通便时间较短(3.5天 vs 5.0天；P =0.0001)。两组间鼻胃管引流时间相似(7.0天vs7.0天；P =0.9502)。CEGA组术后感染的新生儿较少(35.7% vs 60.0%；P=0.038)。
结论
硬膜外麻醉联合全身麻醉可促进新生儿胃肠道手术后胃肠道功能恢复和降低感染风险。
原始文献
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Gannam-Somri L, Matter I, Hadjittofi C. Combined epidural-general anaesthesia vs general anaesthesia in neonatal gastrointestinal surgery: A randomized controlled trial. Acta Anaesthesiol Scand. 2020 Jan;64(1):34-40.
Combined epidural‐general anaesthesia vs general anaesthesia in neonatal gastrointestinal surgery: A randomized controlled trial
Abstractive
Background: Post‐operative ileus is a frequent complication of gastrointestinal surgery under general anaesthesia. The aim of this study was to investigate whether combined epidural‐general anaesthesia is associated with expedited gastrointestinal function recovery in neonates undergoing elective gastrointestinal surgery.
Methods: randomized controlled trial including 60 neonates who underwent gastrointestinal surgery at a university hospital was performed. Thirty neonates received combined epidural‐general anaesthesia (CEGA), and 30 neonates received general anaesthesia (GA) alone. The primary outcome was the post‐operative time to toler‐ance of full enteral nutrition. The secondary outcomes were the post‐operative time defaecation, the duration of nasogastric drainage, and infections.
Results: After excluding two neonates from the CEGA group, where repeated attempts at epidural catheterization were unsuccessful, a total of 58 patients completed the study (CEGA: 28; GA: 30). Full enteral nutrition was tolerated earlier in CEGA vs the GA group (4.0 vs 8.0 days; P=0.0001). Time to defaecation was shorter in the CEGA group (3.5 vs 5.0 days; P=0.0001). Duration of nasogastric drainage was similar between groups (7.0 vs 7.0 days; P=0.9502). Fewer patients in the CEGA group experienced post‐operative infection (35.7% vs 60.0%; P=0.038).
Conclusion: Combined epidural‐general anaesthesia is associated with expedited gastrointestinal function recovery and a lower infection risk after gastrointestinal surgery in neonates.