亚麻醉剂量氯胺酮复合硬膜外麻醉用于妇科腹腔镜手术的临床研究

Clinical effect of Ketamine at subanesthetic dose combined with epidural anaesthesia in laparoscope surgery

目的:探讨亚麻醉剂量氯胺酮复合硬膜外麻醉对妇科腹腔镜手术中二氧化碳气腹引起的不适及呼吸、循环的影响。方法:选择妇科行腹腔镜手术者90例,随机分为硬膜外麻醉复合常规镇静剂组(E1组)、硬膜外麻醉复合常规镇静剂基础上给予亚麻醉剂量氯胺酮组(E2组)、静脉复合全麻组(G组),每组30例,比较各组麻醉前(T1)、气腹前10min(T2)、气腹后15min(T3)、气腹后30min(T4)、气腹关闭后15min(T5)、气腹关闭后30min(T6)时的收缩压(SBP)、舒张压(DBP)、心率(HR)、血氧饱和度(SaO2)、二氧化碳分压(PaCO2)及手术时间、气腹时间、清醒时间,术中、术后不良反应等。结果:气腹后各组HR、SBP及DBP均较气腹前明显升高(P<0.01),G组较E1、E2组上升幅度明显(P<0.05),气腹关闭后接近麻醉前水平;PaCO2在气腹后明显升高(P<0.01),在气腹关闭后明显下降(P<0.01),E1、E2组较G组下降幅度明显(P<0.05);G组术中SpO2较E1、E2组高(P<0.05);G组清醒时间比E1、E2组长;E1组患者在手术过程中各种不适发生率高于E2及G组。结论:亚麻醉剂量氯胺酮复合硬膜外麻醉对呼吸和循环的影响较轻,术中、术后不良反应少,是妇科腹腔镜手术安全、舒适、有效的麻醉方法。

Objective： To evaluate effect of Ketamine at subanesthetic dose combined with epidural anaesthesia on discomfortness due to carbon dioxide pheumoperitoneum, and the effect on respiratory and circulation in laparoscope surgery. Methods： Ninety patients with laparoscope surgery were randomly divided into three groups with 30 cases each： Group E1 with conventional sedative agent combined with epidural anesthesia , Group E2 with Ketamine at subanesthetic dose , conventional sedative agent combined with epidural anesthesia （experimental group） ;Group G with generl anesthesia （control group）. BP, HR, SaO2,PaCO2 , surgery time, pheumoperitoneum time , sober time and adverse effects were all recorded before anaesthesia（T1 ）, at 10 min before pheumoperitoneum（T2 ）, 15 min after pheumoperitoneum（T3 ）, 30 min after pheumoperitoneum（T4）, 15 min after pheumoperitoneum closure（T5）, and 30 min after pheumoperitoneum closure（T6 ）in the perioperative and postoperative period. Results：There were statistically significant increases in HR,SBP and DBP after pheumoperitoneum compared to that before pheumoperitoneum in all groups（P〈0.01）. Group G showed more significantly rising than Group E1 and E2, al mostly as high as the level before anaelgesia. PaCO2 was significantly increased after pheumoperitoneum （P〈0.01）, and significantly decreased as pheumoperitoneum was over（P〈0.01） in all groups, especially in groups E1 and E2 （P〈0.05）. Group G had higher SpO2 and longer sober time than group E1 and E2, In group E1 incidence of adverse effect was higher than in group E2 and group G. Conclusions. Ketamine at subanesthetic dose combined with epidural anaesthesia has less side effect. It is safety, comfortable, and effective in laparoscope surgery.