不同麻醉方法用于腹腔镜胆囊切除术

Different Anesthesia Techniques in Laparoscopic Cholecystectomy

目的比较气管内全麻、腰硬联合静脉麻醉和腰硬联合紧闭面罩吸入麻醉在腹腔镜胆囊手术的麻醉效果。方法随机选择腹腔镜胆囊切除手术患者90例,ASAⅠ～Ⅱ级,随机分三组,Ⅰ组(n=30)采用气管内全麻;Ⅱ组(n=30)采用腰硬联合静脉麻醉;Ⅲ组(n=30)采用腰硬联合紧闭面罩吸入麻醉。结果Ⅰ组收缩压(SBP)、舒张压(DBP)、心率(HR)在麻醉诱导插管及拔管时波动大;Ⅱ组、Ⅲ组麻醉后气腹前SBP、DBP、HR的略有波动,气腹后恢复。Ⅰ组、Ⅲ组在气腹后PH值和PaCO2均在正常范围内;Ⅱ组在气腹后PH值略下降,PaCO2略升高,经面罩吸氧,辅助呼吸,恢复到正常范围内(P>0.05)。结论气管内全麻插管、腰硬联合静脉麻醉和腰硬联合吸入麻醉都可满足腹腔镜手术。腰硬联合吸入麻醉具有操作方便,刺激反应少,苏醒快,病人舒适、安静、无烦躁等优点。

Objective To compare the effect of three anesthesia techniques in anesthesia of lapareseopie eholecystectomy. Methods Ninety patients, ASA Ⅰ - Ⅱ ,undergoing laparoseopie eholecystectomy were randomly divided into three groups： endotracheal anesthesia （group Ⅰ ,n=30）,combined spinal-epidural anesthesia with intravenous anesthesia （group Ⅱ ,n=30） and combined spinal-epidural anesthesia with inhalation anesthesia by veil（group Ⅲ,n=30）. Results In group Ⅰ ,SBP, DBP, HR fluctuated obviously at inducement, intubations and estuations of anesthesia. In group Ⅱ and Ⅲ, SBP, DBP, HR fluctuated a little before gas abdomen and recovered after gas abdomen. PH and PaCO2 in group Ⅰ and Ⅲ was in normal range. PH fell and PaCO2 rose slightly in group Ⅱ, and recover to normal range after inhaling oxygen by veil and assisting respiration. Conclusion All anesthesia techniques are satisfied for laparescopic cholecystectomy. Combined spinal-epidund anesthesia with inhalation anesthesia is convenient, less simulative response, quick recovery and comfort, quiet and no fidget after surgery.