不同麻醉方式对儿童腹腔镜疝囊高位结扎术应激反应的影响

Effect of different anesthesia on stress reaction of laparoscopic hernia sac high ligation in children

目的探讨两种麻醉方法对儿童腹腔镜疝高位结扎术(laparoscopic hernia sac high ligation)应激反应的影响。方法ASAⅠ～Ⅱ级择期行腹股疝疝囊高位结扎术患儿60例,年龄6～12岁,随机分为硬膜外麻醉组(E组)和单纯气管内全麻组(G组)各30例。检测术中不同时点血浆皮质醇(Cor)、去甲肾上腺素(NE)、肾上腺素(E)、促肾上腺皮质激素(ACTH)浓度并观察平均动脉压(MAP)和心率(HR)的变化。结果E组各时点Cor、NE、E、ACHT浓度无明显变化(P>0.05),G组气腹后上述各指标较气腹前明显增高(P<0.05)且显著高于E组同时点(P<0.05)(见表2);E组气腹后平均动脉压及心率变化无统计学意义(P>0.05),而G组的则显著升高(P<0.05);两组患儿气腹10min后PaCO2均显著增加(P<0.05),停气腹后渐恢复至正常,血PH值则变化不明显。结论硬膜外麻醉复合基础麻醉相对于单纯气管内全麻更能有效抑制儿童腹股疝疝囊高位结扎术的应激反应。

Objective To evaluate the effect of two different anesthesia on stress reaction of children underwent laparoscopic hernia sac high ligation in children. Methods Sixty children aged 6 to 12 years old, scheduled for laparoscopic hernia sac high ligation were randomly divided into epidural anesthesia group（Group E, 30 cases） and general anesthesia group（Group G, 30 cases）. The concentration of cortisol （Cor）.norepinephrine （NE）. epinephrine （E）.adrenocorticotrophic hormone （ACTH） were tested at the different point and observed the variation of mean artery pressure （MAP） and heart rate （HR） during operation ,also the arterial blood gas was detected at the same time. Results The concentration of Cor.NE,E.ACTH of group E had no significant changes （P 〉 0.05） after CO2 pneumoperitoneum, but group G increased significantly （P 〈 0.05） after CO2 pneumoperitoneum and it was significantly higher than that group E at the same point; MAP and HR in group E were still unchanged （P〉 0.05） while in group G was remarkably increased after pneumoperitoneum （P〈 0.05）; PaCO2 had significant differences between two groups （P 〈 0.05）;PH remained within the normal range after pneumoperitoneum in both groups. Conclusions As compared with general anesthesia, epidural anesthesia can be safely applied to ASA Ⅰ -Ⅱ grade in the use of laparoscopic hernia sac high ligation in children and can it is better than that general anesthesia for inhibiling stress reaction.