麻醉方式对气腹期间心血管活性肽及血液动力学的影响

Cardiovascular-active Peptide and Hemodynamic Changes during Laparoscopic Cholecystectomy under Different Anesthisia Methods

观察硬膜外麻醉或全身麻醉下CO2气腹对心血管活性肽及血液动力学的影响。方法：选择ASAⅠ－Ⅱ级择期腹腔镜胆囊切除术病人20例，随机分为硬膜外麻醉组（EA组）和全身麻醉组（GA组），各10例。两组均于气腹前、气腹即刻、气腹5min、气腹10min、气腹15min、气腹30min及气腹结束后5min取静脉血，采用放射免疫法检测PRA、AII、ALD、ANP、ET，并同时记录血液动力学指标。结果：①GA组气腹期间PRA、AII及ALD显著升高（P＜0．05），ANP及阿气腹即刻下降（P＜0.05）；血压和心率气腹即刻开始升高（P＜0．05），气腹5min时达峰（P＜0．01），气腹结束5min时恢复至气腹前水平。②EA组气腹期间除ANP降低外（P＜0．05），余各指标无明显变化（P＞0.01）。结论：硬膜外麻醉下,CO2气腹对心血管活性肽及血液动力学的影响较小。

Objective: To observe the cardiovascular-active peptide and hemodynamic changes of patients during carbon dioxide pneumoperitoneum(PNO)under epidural or general anesthesia.Method:Twent ASA I and II patients scheduled for ecective laparoscopic cholecystectomy were randomly assigned to two grous:General (GA,N=10)and epidural(EA,n=10)Ansthesia groups. Plasma comcentrations of renin, angiorensin II, aldosterone, atrial natriuretic polypeptide and endothelin wewe measured by radioimmunoassay at 5 min be fore PNO, during PNO and after exsufflation. Measurements of hemodynamics were done at the same time points.Result:1,In the GA group,plasma coneentrations of renin,angiotenain II and aldosterone were markedly inereased during PNO(P<0.05)Peritoneal insufflation resulted significant reduction of atrial natriuretic polypeptide and endothelin ,Heart rate and arterial blood pressure increased immediately after the beginning of PNO,2.In the EA group,all parameters had no significant change during PNO except ANP was significantly reduced.Conclusions:The cardiovascularactive peptide and hemodynamic changes of patients during earbon dioxide PNO were the mose stable in the EA group.