复合麻醉应用于腹腔镜胆囊切除术的疗效分析

Therapeutic effect of combined anesthesia for laparoscopic cholecystectomy

目的 比较硬膜外联合全身麻醉（CEGA）和全凭静脉麻醉（TTVA）在腹腔镜胆囊切除术中的有效性和安全性.方法 将40例择期行腹腔镜胆囊切除术患者按随机数字表法分为CEGA组和TIVA组,每组20例.比较两组患者的血压、心率、脉搏血氧饱和度、Steward评分、疼痛评分及不良反应.结果 CEGA组术后4、6min时Steward评分[（4.5±0.6）、（5.7±0.2）分]明显高于TTVA组[（2.8±0.4）、（4.1±0.5）分]（P＜0.05）.CEGA组术后2、3、4 h疼痛评分[分别为（1.8±0.3）、（1.5±0.4）、（1.7±0.3）分]明显低于TTVA组[分别为（3.2±0.5）、（3.7±0.4）、（4.2±0.6）分]（P＜0.05）.两组术后腹部疼痛、肩部疼痛及不良反应发生率比较差异均无统计学意义（P＞0.05）.结论 在行腹腔镜胆囊切除术时CEGA比TTVA效果好,也更安全.CEGA可以减少由CO2引起的腹膜激惹现象,可以有效地减轻术中及术后的疼痛,缩短术后苏醒时间,且未增加不良反应发生率.

Objective To compare the efficacy and safety of combined epidural/general anesthesia （CEGA） versus total intravenous anesthesia （TIVA） for laparoscopic cholecystectomy. Methods Forty patients were assigned to group TIVA and group CEGA by random digits table with 20 cases in each. The systolic and diastolic arterial pressure,heart rate, oxygen saturation,Steward score, visual analogue scale （VAS） score and adverse reaction were monitored. Results Steward score 4,6 min after operation in group CEGA [（4.5 ±0.6）, （5.7 ±0.2） scores] was higher than that in group TIVA [（2.8 ±0.4）, （4.1 ±0.5）scores]（P 〈 0.05 ）. The VAS score 2,3,4 h after operation in group CEGA [（ 1.8 ± 0.3 ）, （1.5 ± 0.4）, （1.7±0.3 ） scores] was lower than that in group TIVA [（ 3.2 ± 0.5 ）, （ 3.7 ± 0.4）, （4.2 ± 0.6） scores] （P〈0.05 ）.There was no significant difference in abdomen pain, shoulder pain and adverse reaction between two groups.The incidence of postoperative side effects was lower in both groups （P 〉 0.05）. Conclusions The use of CEGA for laparoscopic cholecystectomy seems to be effective and safe, and to offer some advantages as compared to TIVA alone. CEGA can control pain due to CO2-induced peritoneal irritation, provide excellent infra-operative and postoperative analgesia. CEGA does not require the use of intraoperative intravenous opioids and shortens recovery time, without increasing the incidence of adverse reaction.