喉罩通气全麻复合硬膜外阻滞在上腹部手术中对循环功能和应激反应的影响

The influence of circulation function and stress reaction under general anesthesia of laryngeal mask airway with epidural block in midsection operation

目的 探讨喉罩通气全麻复合硬膜外阻滞在上腹部手术中对循环和应激反应的影响。方法 40例择期行上腹部手术的患者，随机分成两组：A组为喉罩通气全麻复合硬膜外阻滞，B组为单纯气管插管全麻。分别于麻醉前、插管（喉罩）后2min、腹腔探查时、术中60min、拔管后2min静脉采血测血浆去甲肾上腺素（NE）、肾上腺素（E）、血管紧张素-Ⅱ（Ang-Ⅱ）的浓度；记录患者平均动脉压（MAP）、心率（HR）、全麻用药量及术毕清醒时间。结果 A组的NE、E浓度在插管后各时点明显低于B组，A组的MAP、HR在插管后各时点均无异常波动，而B组显著高于麻醉前（P〈0．05）。全麻药用量和术毕清醒时间A组均明显少于B组（P〈0．01）。结论 喉罩通气全麻复合硬膜外阻滞用于上腹部手术可减轻术中的应激反应，循环功能稳定，对生理干扰小，术毕清醒快，是一种较好的麻醉方法．

Objective To research general anesthesia of laryngeal mask airway complex epidural block in midsection operation for the influence of circulation function and stress reaction. Methods Forty patients who would operate in midsection were divide into two groups randomly. Group A was general anesthesia of laryngeal mask airway with epidural block and group B was general anesthesia of catheterization. Concentration of norepinephrine （NE）, epirenamine （E）, angiotensin （Ang）-Ⅱ in plasma were detected at different time （before anesthesia, 2 minutes after intubatton, abdomen exploration, 60 minutes in operation, 2 minutes after drawing cannulation ）. Mean arterial pressure （MAP）, heart rate （HR）, dosage of general anesthesia ang the time of postoperative revival were also observed. Results Each period time of NE and E after intubatton in group A was lower than that in group B. MAP, HR were not exceptional undulation in group A, but they were higher than those in group B before anesthesia（P 〈 0.05 ） . The dosage of general anesthesia and the time of postoperative revival in group A were less than those in group B （P 〈 0.05）. Conclusions General anesthesia of laryngeal mask airway with epidural block in midsection operation, it can reduce stress reaction and physiological interference, circulation ruction is steady, postoperative revival is fast, it is a better anesthesia way.