5842例高血压病患者腹腔镜胆囊切除术的麻醉管理

Management experience of anesthesia on 5842 patients with hypertension disease undergoing laparoscopic cholecystectomy

目的总结5842例高血压病患者行腹腔镜胆囊切除术（LC）的有关麻醉处理的体会。方法气管插管后，静脉滴注1％普鲁卡因＋0.1％琥珀胆碱＋0．0002％芬太尼，按麻醉方法分为前期（采用2．5％硫喷妥钠4—5mg／kg）；中期（采用芬太尼3—4μg/kg＋2．5％硫喷妥钠4mg／kg）；后期（采用芬太尼1—2mg／kg＋异丙酚2mg／kg或依托米酯0.4mg／kg）。结果①中期插管时有187例心率慢于50次／min，38例慢于45次／min。插管时心电图异常者前期有27例，中期65例，后期103例。麻醉诱导期血压下降≥3kPa占25．4％，窥喉行气管插管时血压升高〉3kPa占68、6％，术中发生高血压危象48例，经及时处理均稳定。②诱导期中PetCO2由气腹前（3.72±0.15）kPa升至（4．33±0．16）kPa，术毕恢复至术前水平。结论高血压病患者行LC围术期的正确处理是麻醉手术成功的关键，后期麻醉诱导方法对心血管影响较小，适合于高血压病患者。

Objective To discuss the experience of anesthesia on the patients with hypertension disease undergoing laparoscopic cholecystectomy. Methods The patients were divided into three groups. In group Ⅰ,anesthesia was induced by thiopentone 4 -5 mg/kg;In group Ⅱ,by fentanyl 3 -4 μg/kg and thiopentone 4 mg/kg;In group Ⅲ,by fentanyl 1 -2 μg/kg and propofol 2 mg/kg or etomidate 0. 4 mg/kg. In these patients, anesthesia were maintained by continuous intravenous injection of 1% procain,0. 1% suxamethonium and 0. 0002% fentanyl in 187 after intubation. Results （1）In group Ⅱ,during intubation period,heart rate was slower than 50 beats/ min in 187 cases,slower than 45 beats/min in 38 patients . Abnomal EKG was found in 27 cases in group Ⅰ when intubation,65 cases in group Ⅱ,103 cases in group Ⅲ. Over 3 kPa blood pressure reduction was seen in 25.4% cases during induction of anesthesia. Over 3 kPa blood pressure rise was seen in 68.6% patients during intubation. Hypertension crisis took place in 48 patients, which was tackled down by proper treatment. （2）PetCO2 increased from （3. 72 ± 0. 15 ）kPa to （4. 33 ±0. 06）kPa during induction period. Conclusion The proper anesthesia method is the key point to perform successful operation and anesthesia on the patients with hypertension undergoing laparoscopic cholecystectomy. The anesthesia method used in group m has less cardiovascular side effects, so it may be the best choice for the patients with hypertension undergoing laparoscopic cholecystectomy.