妇科腹腔镜手术患者不同麻醉状态应激反应的临床分析

Clinical analysis of the stress response of different anesthesia in gynecological laparoscopic surgery patients

目的观察比较全麻和全麻复合硬膜外麻醉对妇科腹腔镜手术患者应激反应的影响。方法 68例妇科腹腔镜手术患者随机分为全麻组和硬膜外麻醉组,监测气腹前后HR、SBP、DBP、MAP、血浆肾上腺素(E)、去甲肾上腺素(NE)、血糖、皮质醇浓度及血气分析变化。结果两组HR、SBP、MAP均有不同程度的升高,全麻组较硬膜外组升高差异有显著性(P<0.05);全麻组E、血糖均显著升高,硬膜外组无显著变化,两组间差异有显著性(P<0.05);两组皮质醇均显著升高,组间差异有显著性(P<0.05);两组气腹后均出现PaCO2升高,pH降低,差异无显著性(P>0.05)。结论妇科腹腔镜手术硬膜外麻醉引起的应激反应轻,对循环功能影响小。

【Objective】To compare general anesthesia and general anesthesia combined with epidural anesthesia for gynecological laparoscopic surgery stress response.【Methods】68 cases of gynecologic laparoscopic surgery were randomly divided into two general anesthesia group and epidural anesthesia group to monitor the pneumoperitoneum before and after HR,SBP,DBP,MAP,plasma epinephrine （E）,norepinephrine （NE）,blood glucose ,cortisol concen-tration and changes in blood gas analysis. 【Results】HR,SBP,MAP of two groups were increased in varying degrees. Compared with epidural anesthesia group,general anesthesia group was significantly different. E,blood glu-cose of general anesthesia group were significantly increased,epidural group had no significant change; cortisol were significantly increased,PaCO2 were significantly increased after pneumoperitoneum for two groups,while pH de-creased was not statistically significant. 【Conclusions】The gynecologic laparoscopic surgery in the stress response caused by epidural anesthesia and light little effect on the circulatory function.