两种不同麻醉方法在腹腔镜手术中的对比研究

Comparative Study of Two Different Anesthetic Techniques in Laparoscopic Surgery

目的探讨单纯全麻与硬膜外联合全麻用于腹腔镜手术的临床效果。方法将拟行腹腔镜手术患者70例随机分为全麻组(A组)和硬膜外联合全麻组(B组),每组各35例。术中连续监测血压(BP),心率(HR),血氧饱和度(SpO2),心电图(ECG)和气道压(设定气腹前为T1,术毕放气后为T3);测定患者麻醉前(T0)、气腹后20min(T2)及术毕拔除气管导管后5min(T4)3个时点的血气指标;观察并记录两组患者术后苏醒时间、呼之睁眼时间、拔管时间及术后烦躁发生率和术后肺部感染率。结果 A组患者在T2、T4时的SBP、DBP和HR与T0比较均有明显升高(P<0.05);B组患者各时点SBP、DBP和HR变化不大,差异无统计学意义(P>0.05)。在T2、T4时两组之间比较差异有显著性(P<0.05)。在T2时两组患者气道压均升高,但A组升高更明显(P<0.01);两组之间比较,T2时差异有显著性(P<0.05),而T3时无显著性(P>0.05)。两组患者只有T2时HCO3-明显高于T0(P<0.05),其余指标在各时点变化不大,差异无统计学意义(P>0.05);两组患者组间比较差异无显著性(P>0.05)。术后苏醒时间、呼之睁眼时间和拔管时间两组患者组间比较差异无显著性(P>0.05),躁动发生率和肺部感染率A组明显高于B组(P<0.01或P<0.05)。结论硬膜外联合全麻的麻醉效果优于单纯全麻,是腹腔镜手术的良好麻醉选择。

Objective To compare the effect of general anesthesia and epidural anesthesia in laparoseopie surgery. Methods Seventy patients scheduled for select laparoseopic surgery who were randomly divided into general anesthesia group （Group A） and epidural anesthesia group（Group B）, 35 cases in each group. BP, HR, SpO2, ECG and airway pressure （set before pneumoperitoneum was T1 and after the surgery deflated was T3） were continuously monitored. Determine the blood gas in before anesthesia （To）, after the surgery deflated 20min （T2） and removal the endotracheal tube of surgery 5 min（T4）, observed and recorded two groups of patients in postoperative recovery time, eyes and call time, extubated time,.the incidence of postoperative irritability and postoperative pulmonary infection. Result The patiens in group A, the SBP, DBP and HR in T2, T4w was significantly higher than To （P〈0.05）, the SBP, DBP and HR have a little change at each time point in group B, no significant difference between （P〉0.05）, differences have a significant in Tz, T4 two groups （P〈0.05）, two groups of patients with airway pressures were increased at T~, but the group A was increased more significantly （P〈0.01）, between the two groups, significant difference at Tz （P〈0.05） and no significant difference at T3 （P〉0.05）, two groups of patients with Tz HCO3- significantly higher than To （P〈0.05）, little change in other indicators at each time point, no significant difference between （P〉0.05）, difference between the two groups of patients was no significant, there was no significant difference in postoperative recovery time, eyes and call time, extubated time between two groups （P〉0.05）, the incidence of postoperative irritability and postoperative pulmonary infection the group A was significantly higher than the group B （P〈0.01 or P〈0.05）. Conclusion Epidural anesthesia, the anesthetic effect is better than that of general anesthesia ,was the good anesthetic choice for laparoscopic surgery.