全麻复合硬膜外阻滞在腹腔镜胆囊切除术中的应用

Application of combined use of general anesthesia and epidural block in patients undergoing laparoscopic cholecystectomy

目的探讨全麻复合硬膜外阻滞在腹腔镜胆囊切除术(LC)中的应用效果。方法 LC患者40例随机均分为两组,分别采用全麻复合硬膜外阻滞(A组)和单纯全麻(B组)。比较两组麻醉前10min(T0)、气腹10min(T1)和停气腹后5min(T2)的MAP、HR、血糖(BG)、C-反应蛋白(CRP)、IL-6、肾上腺素(E)和去甲肾上腺素(NE)浓度。结果 B组T1时的MAP和HR明显高于T0和A组(P<0.05)。B组T1、T2时的E、NE、IL-6和T2时的CRP均明显高于T0和A组(P<0.05)。A组术后清醒及拔管时间明显短于B组(P<0.05)。结论相对于单纯全麻,全麻复合硬膜外阻滞则能较好地抑制手术应激反应。

Objective To investigate the outcomes of combined use of general anesthesia and epidural block in patients undergoing laparoscopic cholecystectomy （LC）. Methods Forty patients undergoing LC were equally assigned into groups of A （anesthesia with combined use of general anesthesia and epidural block） and B（anesthesia with general anesthesia alone）. The MAP, HR, blood glucose（BG）, C-reactive protein （CRP）, epinephrine （E） and norepinephrine （NE） were measured before anesthesia （T0）, at 10 rain during pneumoperitoneum （T1） and 5 rain after deflation （T2）. Results The MAP and HR at T1 in group B were higher than those at TO and those in group A （P〈0. 05）. The levels of BG, E, NE and IL-6 at T1 and T2 and CRP at T2 in group B were higher than those at TO and those in group A （P〈0. 05）. The times of awakening and extubation were shorter in group A than those in group B （P〈0. 05）. Conclusion Compared to general anesthesia alone, combined use of general anesthesia and epidural block has a better suppressive effect on stress responses in patients undergoing LC.