腹腔镜胆囊切除术CO_2充气时的心血管反应

Cardiovascular Reaction during Intraperitoneal CO_2 Insufflation of Laparoscopic Cholecystectomy

45例腹腔镜胆囊切除术患者,随机分为全麻组、硬膜外组、硬膜外+阿托品组,观察CO_2气腹建立时的心血管反应。结果表明,全麻下腹腔充气时血压、心率轻度上升,硬膜外阻滞下(T_4～L_1)腹腔充气易诱发严重迷走神经反射。气腹前静注常规剂量阿托品对其反射有一定的抑制作用,而对充气时血压下降的预防效果不明显。为此,必须加强气腹期间监测和管理,合理选择麻醉方法。

Forty-five patients, undergoing laparoscopic cholecystectomy, were equally randomly divided into general anesthesia, epidural and epidural plus atropine group. The cardiovascular reaction during intraperitoneal CO2 insufflation was observed. The results show that blood pressure and heart rate were raised slightly during the intraperitoneal insufflation under general anesthesia. The severe vagal reflex was induced easily by the intraperitoneal insufflation under epidural blockade (T4-L1). The ordinary dose of atropine administered intravenously before pneumoperitoneum could not inhibit the vagal reflex completely, and could not prevent effectively blood pressure drop caused by the insufflation. Therefore, the monitoring and management should be intensified during pneumoperitoneum, and anesthetic method should be selected reasonably.