腹腔镜直肠癌根治术不同麻醉方法对应激反应的影响

The effect of different anesthetic methods on stress response during the radical operation of rectal carcinoma by laparoscopy

目的:观察腹腔镜直肠癌根治术不同麻醉方法对应激反应的影响,为腹腔镜直肠癌根治术选择理想的麻醉方法。方法:直肠癌根治术患者48例,ASAⅠ或Ⅱ级,随机分为腰—硬联合阻滞复合全麻组(Ⅰ组)和单纯全麻组(Ⅱ组)各24例。持续监测MAP、HR、SpO2和PETCO2,分别于麻醉前(T1)、气腹前5min(T2)、二氧化碳气腹(压力达12mmHg)后10min(T3)、放气后5min(T4)抽静脉血测定血糖(Glu)和血浆皮质醇(Cor)。结果:Ⅱ组在T3时MAP、HR、Glu和Cor均明显高于Ⅰ组(P<0.05),Ⅰ组和Ⅱ组T3时PETCO2均高于T1和T2时(P<0.05)。结论:腰—硬联合阻滞复合全麻比单纯全麻可更有效抑制腹腔镜直肠癌根治术的应激反应,是腹腔镜直肠癌根治术理想的麻醉方法。

Objective：To observe the effect of different anesthetic methods on stress response during the radical operation of rectal carcinoma by laparoscopy.Methods：Forty-eight patients with rectal tumor graded as ASA I or II for radical operation by laparoscopy were randomly divided into the group of the general anesthesia and the epidural anesthesia combined with the spinal anesthesia （group I） and the group of general anesthesia alone （group II） with each group included 24 patients.The MAP,HR,SpO2 and PETCO2 were monitored continuously.Blood glucose （Glu） and plasma cortisol （Cor） were measured before anesthesia （T1）,5 minutes before （T2） and 10 minutes after （T3） pneumoperitoneum with CO2,5minutes after releasing the gas （T4）.Results：The MAP,HR,Glu and Cor in group I were higher than those in group II at T3 （P〈0.05）.The PETCO2 at T3 was higher than that at T1 and T2 （P〈0.05）.Conclusions：Compared with general anesthesia alone,the general anesthesia and epidural anesthesia combined with spinal anesthesia can effectively suppress the stress response during the radical operation of rectal tumor by laparoscopy.