静脉异丙酚复合硬膜外麻醉用于腹腔镜胆囊切除术的临床观察

Cinical observation of the analgesic effects of epidural anesthesia combined with propofol during laparoscopic cholecystectomy

目的观察异丙酚复合硬膜外麻醉用于腹腔镜胆囊切除术时呼吸和循环的变化,评价其实用性和安全性。方法选择60例ASAⅠ～Ⅱ级择期腹腔镜胆囊切除术病人,随机分为异丙酚复合硬膜外麻醉组(P组)和单纯硬膜外麻醉组(E组)。结果E组硬膜外给药后SBP、MAP、DBP、HR明显降低,P组收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)在异丙酚后3分钟下降(P<0.01),其中28例(93.33%)仍属正常范围。E组术中血压明显低于P组,两组相比有显著意义(P<0.05)。P组VT、SPO2在泵入异丙酚后有所下降,PETCO2增加,但仍在正常范围,与E组相比有显著意义(P<0.05)。结论异丙酚复合硬膜外麻醉用于LC手术,术中能达到良好的镇痛和镇静,是一种理想安全的麻醉方法。但应注意两者复合对呼吸和循环的抑制作用。

Objective To observe the change of respiratory system and circulation when use epidural anesthesia with propofol during laparoscopic cholecystectomy,and evaluate its practicability and security. Methods Sixty cases scheduled for caparoscopic cholecystectomy(LC) were randomly divided into the epidural anesthesia with combined propofol anesthesia group(Group P n=30)and the simple epidural anesthesia group (Group E n=30).Results In group E,SBP?MAP?DBP?HR were obviously dreased after epidural injection.In group P, SBP?DBP?MAP?HR were decreased at 3 min after the beginning of propofol injection(P < 0.01).Among them, 28(93.33%) patients were in normal limit. The BP of Group E was lower than that in Group P during operation. There was significantly different between the two groups. In group P, VT?SPO2 were decreased after the beginning of propofol injection (P < 0.01), PETCO2 was increased,but it was still in the normal limit. There were significant difference comparing with Group E(P < 0.05). Conclusion The use of epidural anesthesia combined with propofol is safe and effective during laparoscopic cholecystectomy,but its inhibition for respiratory system and circulation must be noticed.