不同麻醉方法用于妇科腹腔镜手术的效果观察

Effect observation on different anesthesia for gynecological laparoscopy

目的:比较全麻(GA)和腰-硬联合麻醉(CSEA)在妇科腹腔镜手术中的安全性和可行性。方法:将45例择期妇科腹腔镜手术患者按随机数字法分为GA组24例和CSEA组21例。比较两组不同时段MAP、HR及动脉血气分析情况,观察并记录两组不良反应、术后清醒时间及术后并发症的发生情况。结果:两组患者在气腹后30min的MAP、HR均较麻醉前明显增高(P<0.01),CSEA组在气腹后60min的MAP、HR仍较麻醉前高(P<0.01或P<0.05),而GA组基本保持麻醉前水平。CSEA组气腹后30、60min动脉血气pH值较麻醉前明显降低(P<0.01),PaCO2明显增加(P<0.01);而GA组pH、PaCO2较麻醉前改变不明显(P>0.05)。GA组和CSEA组术中不良反应发生率分别为0.04%和0.19%,两组比较,差异有统计学意义(P<0.05)。两组术后清醒时间比较,差异无统计学意义(P>0.05)。两组术后均未出现与麻醉相关的并发症。结论:妇科腹腔镜手术中应用全麻能更好地控制机体的应激反应,是一种效果佳、实用可行的麻醉方法。

Objective： To compare the safety and feasibility of general anesthesia （GA） and spinal and epidural anesthesia （CSEA） in laparoseopic surgery. Methods： 45 patients undergoing elective laparoscopic surgery patients were randomly divided into 24 cases of GA group and 21 cases of CSEA group. MAP, HR and arterial blood gas analysis of different times were compared, the adverse reactions, time awake after surgery and postoperative complications of two groups were observed and recorded. Results： MAP, HR of patients in the pneumoperitoneum after 30 min was significantly higher than those before anesthesia （P〈0.01）, MAP, HR of CSEA group in the pneumoperitoneum after 60 rain was still higher than those before anesthesia （P〈0.01 or P〈0.05）, while the GA group remained before anesthesia. The arterial blood gas pH values CSEA group after pneumoperitoneum 30, 60 rain significantly lower than that before anesthesia （P〈0.01）, PaCO2 increased significantly （P〈0.01）; and in GA groups, pH, PaCO2 had no significant change compared with before anesthesia （P〉0.05）. The intraoperative adverse reaction rates of GA group and CSEA group were 0.04% and 0.19%, the difference was statistically significant （P〈0.05）. The difference of postoperative awake time between two groups was not statistically significant （P〉0.05）. No postoperative complications occurred associated with anesthesia. Conclusion： The application of laparoscopic surgery in general anesthesia can better control the body＇s stress response, it is a good effect, practical and feasible method of anesthesia.