两种不同麻醉方式在妇科腹腔镜手术中的效果分析

Two different anesthesia methods in gynecological laparoscopic surgery

目的:探讨气管插管下全麻与硬膜外麻醉两种不同麻醉方式在妇科腹腔镜手术中的麻醉效果及不良反应。方法:选取行妇科腹腔镜手术的80例患者,随机分为两组,各40例,一组给予硬膜外麻醉,一组给予气管插管下全麻麻醉,观察气腹开始前、气腹后15 min、术毕15 min时血氧饱和度(SpO2)、呼气末二氧化碳分压(PE TCO2)、收缩压(SBP)、舒张压(DBP)、心率(HR)变化及不良反应、术中肌肉松弛程度等。结果:两组患者手术时间、气腹时间比较差异无统计学意义(P>0.05),停药-苏醒时间硬膜外麻醉组较全麻组短(P<0.05);两组患者气腹前SpO2、PE TCO2、SBP、DBP、HR比较差异无统计学意义(P>0.05),气腹15min时SBP、DBP、HR、PE TCO2比较气腹前明显升高,SpO2较气腹前下降,差异有统计学意义(P<0.05),硬膜外麻醉组SBP、DBP、HR、PE TCO2升高和SpO2下降幅度更大,与全麻组比较差异有统计学意义(P<0.05);硬膜外麻醉组肌松程度评分明显低于全麻组,疼痛评分高于全麻组,差异有统计学意义(P<0.05)。结论:硬膜外麻醉与气管插管下全麻均能用于妇科腹腔镜手术麻醉,硬膜外麻醉术后患者苏醒较快,但全麻安全系数更高,术中麻醉效果更好。

Objective. To explore the effects of trachea cannula under general anesthesia and epi dural anesthesia in gynecological laparoscopic surgery and to observe the adverse reaction. Methods. A to tal of 80 patients underwent gynecological laparoscopic surgery were randomly divided into two groups with 40 cases in each group, a group was given epidural anesthesia, the other was given endotracheal intu- bation anesthesia under general anesthesia, and to observe changes in blood oxygen saturation （SpOz）, end-tidal carbon dioxide partial pressure （PETCOz）, systolic blood pressure （SBP）, diastolic blood pres- sure （DBP）, heart rate （HR） at 3 time points including before pneumoperitoneum, 15 min after pneumo- peritoneum, 15 min after the operation. Results： No significant difference in operative time, pneumoper- itoneum time was observed between the two groups （P^0. 05）, but drug withdrawal-revival time was shorter in epidural anesthesia group （P^0.05）7 No significant difference in SpO2 and PETCOz, SBP, DBP, HR was found before pneumoperitoneum （P^0. 05）, but 15 min after pneumoperitoneum, SBP, DBP, HR, PETCO2 increased significantly, SpO2 decreased （P both d0.05） in both groups, which were more obvious in epidural anesthesia group （P^0.05）. Muscle loose degree score of the epidural anesthesia group was lower than the general anesthesia group, pain score higher than general anesthesia group （P both ~ 0.05）. Oonclusion. Both epidural anesthesia and endotracheal intubation anesthesia can be applied in gynecological laparoscopic surgery, but the former method shows shorter revive time, better safety and better anesthesia effects.