妇科腹腔镜手术硬膜外麻醉和气管内插管全身麻醉的效果比较

Comparison of Epidural Blockade Versus General Anesthesia during Gymecology Surgery by Celioscope

目的比较硬膜外麻醉和气管内插管全身麻醉在妇科腹腔镜手术中的应用效果，方法选择择期妇科腹腔镜手术患者100例，ASAⅠ～Ⅱ级，随机分为硬膜外麻醉组（E组）和气管内插管全身麻醉组（G组），每组50例，E组选择L1,2和T11,12两点硬膜外穿刺，G组采用气管内插管全身麻醉。所有病人麻醉后，连续监测平均动脉压（MAP）、中心静脉压（CVP）、心电图（ECG）、脉搏血氧饱和度（SpO2）、心输出量（CO）、心率（HR）和呼气末二氧化碳分压（PETCO2）。记录两组患者CO2气腹前（T0），气腹后5（T1），10（T2），15（T3），30min（T4）及停气腹后5min（T5）的MAP，CVP，CO，HR，PETCO2。两组病人均在气腹前（T0），气腹后5min（T1），15min（T3），30min（T4）及停气腹后5min（L）经桡动脉抽血作血气分析和测血糖（GLU），并记录动脉血CO2分压（PaCO2）、酸碱值（pH）、碳酸氢根浓度（HCO3^-）、动脉血氧分压（PaO2）和血糖值（GLU）。结果E组气腹后5min，10min HR明显降低（P〈0．05），15min后恢复到气腹前水平，G组气腹后HR无明显变化（P〉0．05），两组间比较，差异无显著性；气腹后G组MAP显著升高（P〈0．05），至停气腹后5min仍未恢复到气腹前水平，而E组整个气腹期间MAP无明显变化或略低（P〉0．05），与G组比较差异有显著性（P〈0．01）；气腹后两组病人的CO均显著下降（P〈0．05），10min后开始回升，30min后恢复到气腹前水平（P〉0．05），两组间比较差异无显著性。结论妇科腹腔镜手术应用气管插管全身麻醉并不明显优于硬膜外麻醉，而硬膜外麻醉在降低气腹造成的循环高动力以及降低应激反应方面尚有一定的优越性。

Objective Tn compare the different effects between epidural blockade and general anesthesia during gymecology surgery by celioseope. Methods One hundred ASA Ⅰ-Ⅱ gynecology patients operated undergoing celioscope were choosed. All patients were randomly divided into two groups ： （E） epidural blockade （ n = 50 ） and （G） general anesthesia （ n = 50）. Members in group E were punctured in L1,2 and T11,12 and place catheter 4cm partly faeing head and fool. The local anesthesia is 2%, lidoeaine. All menbers in the group breathe oxygen by face mask during the whole journey, keep SpO2≥98%. In group G,members were injected fentanyl 4μg/kg. propofol 2mg/kg and veeuronium 0. 1mg/kg hefore tracheal eannnla and control the breath by anesthesia machine. Propofol is given by 6mg/kg in Persistence during anaesthesia. Fentanyl and vecuronium are given by patients need. All patients＇ MAP, CVP, HR, CO, SpO2, ECG and PETCO, are monitored eontinuously. Record MAP, CVP, CO, HR, PETCO2 before pneumoperitoneum and at 5min, 10min, 15min, 30min after pneumoperitoneum. measure glucose and record PaCO2 ,pH,HCO3^- ,PaO2 ,glucose. Results Mean arterial pressure（MAP） in the group G remarkably increased after pneumoperitoneum（ P 〈0.05 ） and remaioed at a high level 5min after the removal of pneumnperitoneum while the MAP in the group E remained unchanged nr mildly depresseed during the course of pneumoperitoneum （ P 〉 0.05 ） , with significant differences between the two groups （ P 〈 0.01 ） ;In both groups the cardiac output （ CO） deereased significantly after CO2 pneumoperitnneum （ P 〈 0. 05 ）, hegan to increase 10min later and returned to the level before pneumoperitoneum 30min later（ P 〉0.05） ,without significant differences between the two groups, the PaCO2, HCO3^- , pH, PaO2 remained within normal range after pneumoperitoneum in hoth groups, without elinical signifieanees.Conclusion General anesthesia is not superior to epidural blocade daring gynecology surgery by celioscope.In the contrary,there is a relative advantage in redueing the high systemic vascular resistanee and the stimulation mode by pneumoperitoneum in epidaral anesthesia.