异丙酚复合硬膜外麻醉与全麻下行腹腔镜胆囊切除术的对比研究

目的比较异丙酚复合硬膜外麻醉与静吸复合全麻对腹腔镜胆囊切除术患者呼吸、循环功能的影响,探讨异丙酚复合硬膜外麻醉应用于腹腔镜胆囊切除术的可行性。方法选择60例拟行腹腔镜胆囊切除术患者,随机分为A、B两组。A组(n=30)采用静吸复合全麻,B组(n=30)采用异丙酚复合硬膜外麻醉,分别于麻醉前(T1)、麻醉后气腹前(T2)、气腹后5min(T3)、气腹后15min(T4)、气腹后30min(T5)和放气后5min(T6)6个时点观察SBP、DBP、RR、HR和SpO2的动态变化,以及术中牵拉反应、恶心呕吐、术后躁动等不良反应发生率。结果与麻醉前(T1)比较,A组各时点指标差异无显著性(P>0.05),B组气腹后血压、心率降低,呼吸增快,差异有显著性(P<0.05);与A组比较,B组气腹后血压、心率降低,差异有显著性(P<0.05)。B组恶心呕吐、术后躁动发生率低于A组。结论对ASAI～II级患者异丙酚复合硬膜外麻醉行腹腔镜胆囊切除术能一定程度上减轻应激反应,可以提供良好的麻醉效果,经济可行。

Objective To compare the effect of epidural anesthesia combined propofol and intratracheal general anesthesia on patients＇ respiratory and circulation functions during laparoscopic cholecystectomy（LC）,and to explore the feasibility of epidural anesthesia combined propofol for LC. Methods 60 patients undergoing LC were divided into general anesthesia group （group A,n=30）and epidural anesthesia combined propofol group （group B,n=30）randomly, The SBP,DBP,RR,HR and SpO2 were measured before anesthesia （T1）, after anesthesia（T2）, 5 min（T3）, 15min（T4）, 30min（T5） after peritoneal insufflation of C02,and 5 min after operation（T6）. Results Compared with Tl,the differences at every time in group Awere not significant（P〉0.05）. BP in group B was degrade and HR was slower after pneumoperitoneum （P〈0.05）, while RR was faster （P〈0.05）; Compared with group A ,BP in group B was degrade （P〈0.05） and HR was slower （P〈0.05） after pneumoperitoneum. The incidence of the side effect of group B was lower than group A. Conclusion Propofol combined epidural block can reduce stress reaction and provide the satisfactory anesthetic effect for ASAⅠ-Ⅱ patients during laparoscopic cholecystectomy.