硬膜外阻滞下行全宫切除术腹腔探查时对循环和动脉血气的影响

Effects of Intraabdominal Exploration on Circulation andArtery Blood Gas in Laparohysterectomy under Epidural Analgesia

本文研究发现在连硬膜外麻醉下行腹腔探查时病人ＳＡＰ、ＤＡＰ、ＨＲ均下降（Ｐ＞０．０５），而当塞棉垫时则下降更甚（Ｐ＜０．０５），动脉血气检查发现进腹腔探查时动脉血氧分压（ＰａＯ＿２）下降（Ｐ＞０．０５），塞棉垫时则显著下降（Ｐ＜０．０５），而动脉血二氧化碳分压（ＰａＣＯ２）及氢离子浓度变化无统计学意义（Ｐ＞０．０５）。其机理是全宫切除术进腹探查，特别是塞棉垫时，因强烈的刺激，导致有害的迷走－迷走神经反射及机械压迫作用，引起动脉血压及心率明显下降，亦导致呼吸功能紊乱，如ＰａＯ２下降等。这些变化对病人极其有害，特别是有循环及时吸系统疾患者，严重者可危及生命。

he hemodynamics and artery blood gas analysis were examined in 20 patients undergoing laparohysterectomyunder continous epidural analgesia. Duriug manual intra-abdominal exploration, SAP and DAP decreased, and HRslowed slightly (P> 0.05), PaO2 reduced nonsignificantly.However,there was a marked decrease in SAP, DAPHR and PaO2 (P<0. 05)following retrouterine gauze padding, but with litte change in PaCO2 and pH, Our findingsshow that the mechanical stimuli in laparohysterectomy under epidural analgesia might lead to serious disturbancesboth in circulation and respiration via the vagal reflex. These changes are harmfuI to the patients with cardiovascu-lar or respiratory dioeases. Means to avoid these changes needs to be studied further.