两种麻醉方法对妇科腹腔镜手术患者血流动力学的影响

Effect of different anesthesia methods on hemodynamics in gynecological laparoscopic operation

目的观察硬膜外腔阻滞麻醉和全身麻醉在妇科腹腔镜手术中对患者血流动力学的影响。方法106例妇科腹腔镜手术患者按数字表法随机分为两组：全麻组和硬膜外组各53例，分别于麻醉前、气腹后20min、术毕放气后10min检测两组心率、收缩压、舒张压、血氧饱和度等变化。结果硬膜外组清醒时间（7．1±2．5）min明显快于全麻组的（20．8±6．3）min（t=2．068，P〈0．05），气腹后20min，全麻组的心率（91±17）次／min明显快于麻醉前（t=2．593，P〈0．05），且明显高于硬膜外组（t=3．417，P〈0．05）；气腹后20min，硬膜外组的血氧饱和度较麻醉前明显下降（t=2，806，P〈0.05），且明显低于全麻组（t=3．917，P〈0，05）。结论妇科腹腔镜手术全麻并不明显优于硬膜外麻醉，但二者均应加强临床血流动力学的检测。

Objective To observe the effects of peridural and general anesthesia on haemodynamics in gyne- cological laparoseopie operation. Methods 106 patients with gynecological laparoscopic operation were randomly divided into epidural anesthesia group（ n = 53） and general anesthesia group（ n = 53 ） respectively. The changes of heart rate （ HR）, systolic Mood pressure （SBP） , diastolic blood pressure （ DBP）, SpO2 were monitored before anesthesia, at 20min after pneumoperitoneum（pp） ,end of operation. Results The sober time in epidural anesthrsia geoup（7.1± 2. 5 ） rain was significantly faster than that in general anesthesia group （ 20. 8 ±6. 3 ） min （ t = 2. 068, P 〈 0. 05 ）. At 20min after pp, HR in general anesthesia group （91± 17） was significantly faster than that in epidural anesthesia group before anesthesia （ t = 2. 593, P 〈 0.05 ）, and it was significantly higher than epidural anesthesia group （ t = 3.417,P 〈0. 05 ）. SBP in epidural anesthesia group was singnificantly lower than before anesthesia （ t = 2. 806, P 〈0. 05 ）, and it was significantly lower than general anesthesia group （ t = 3.917, P 〈0. 05 ）. Conclusion General anesthesia does not significantly better than epidural anesthesia in gynecological laparoscopic operation,but they should enhance the clinical monitoring of hemodynamics.