全麻和硬膜外麻醉在妇科腹腔镜手术中的应用

Application of general anesthesia and epidural anesthesia in gynecologic laparoscopic surgery

目的:比较复合全身麻醉(全麻)与连续硬膜外麻醉在妇科腹腔镜手术中的麻醉效果与安全性。方法:回顾性分析我院2008年6月～2010年3月收治的60例择期行腹腔镜妇科手术患者的临床资料。结果:两组患者气腹后20～30 min,pH值、PaCO2与气腹前比较,差异均有统计学意义(P<0.05)。两组病例SBP、DBP、HR变化及其他指标比较,差异无统计学意义(P>0.05)。全麻组无不良反应发生;硬膜外麻醉组1例出现短暂呼吸抑制,3例术后出现头昏,30 min后自行消失。结论:气管插管静脉全麻更适合用于妇科腹腔镜手术的麻醉,尤其在防止低血压、控制患者二氧化碳蓄积方面明显优于硬膜外复合静脉麻醉。

Objective： To compare the efficacy and safety of general anesthesia and continuous epidural anesthesia in gynecologic laparoscopic surgery.Methods： The data of 60 patients treated with elective laparoscopic gynecologic surgery in our hospital from June 2008 to March 2010 were analyzed retrospectively.Results： The pH value and PaCO2 of patients after pneumoperitoneum at 20-30 minutes of the two groups were compared to those before pneumoperitoneum,there were significant differences（P〈0.05）.SBP,DBP and HR of the two groups had no significant difference before and after pneumoperitoneum（P〈0.05）;general anesthesia group showed no adverse reaction;epidural anesthesia group had 1 case of transient respiratory depression,3 cases had dizziness and disappeared after 30 minutes.Conclusion： Tracheal intubation is more suitable for intravenous anesthesia in gynecologic laparoscopic surgery,especially superior to epidural and intravenous anesthesia in the prevention of hypotension and control of patients with accumulation of carbon dioxide.