腹腔镜子宫切除术三种麻醉方法的对比研究

A Comparing Study of Different Anesthetic Methods for Patients during Laparoscopic Hysterectomy

目的观察不同麻醉方法对腹腔镜子宫切除术患者应激反应的影响。方法选择行腹腔镜子宫切除术患者45例,随机分为3组:硬膜外麻醉组(A组)、全麻组(B组)、全麻复合硬膜外阻滞组(C组)各15例,于麻醉前10min(T_0)、气腹后10min(T_1)、气腹后40min(T_2)和术后10min(T_3)4个时间点,采集静脉血测定血糖(BG)、儿茶酚胺(CA)、C反应蛋白(CRP)和白介素-6(IL-6)浓度,并观察P_(ET)CO_2、SpO_2及血流动力学变化。结果与T_0相比,A组T,时MAP、HR显著下降(P<0.05),B组T_1、T_2时MAP、HR、BG和CA明显升高(P<0.05),C组各时点MAP、HR、BG和CA差异无统计学意义,T_1、T_2、T_3时3组CRP和IL一6显著升高(P<0.05);组间相比,C组各时点MAP、HR、BG、CA、CRP和IL-6显著低于B组(P<0.05)。结论全麻复合硬膜外阻滞能有效地调控腹腔镜子宫切除术患者的应激反应。

Objective To study the effects of different anesthetic methods on stress response in patients during laparoscopic hyster-ectomy. Methods 45 patients scheduled for laparoseopic hysterectomy were randomly divided into three groups ： group A （ n = 15 ） , group B（n = 15） and group C （n = 15）. blood samples was taken from patients in each group before anaesthesia,at 10 min and 40 min after pneumoperitomeum with CO2,10 min after operation, to determine the glucose （BG） , eateeholamine （CA） , C -response protein （CRP） and interleukins -6（IL -6）. The changes of MAP ,HR,PETCO2and SpO2 were also recorded. Results After anesthesia,the MAP, HR significantly decreased in group A （ P 〈 0.05 ） ,and the MAP, HR BG, CA, CRP and IL - 6 increased significantly in group B （ P 〈 0. 05 ）. These was no significant difference in the levels of MAP, HR, BG and CA among all time points in group C （ P 〉 0.05 ）. Conclusion Combined general epidural anesthesia can effectively inhibit the stress response in patients undergoing laparoscopie hysterectomy.