罗哌卡因硬膜外麻醉与丙泊酚联合舒芬太尼全身麻醉对妇科腹腔镜手术患者呼吸、循环和动脉血气的影响

Effects of Ropivacaine Epidural Anesthesia and Propofol Combined with Sufentani General Anesthesia on Cardiovaseular and Respiratory Systems Function and Arterial Blood Gas in Patients underwent Gynecology Laparoseopic Operation

目的:比较罗哌卡因硬膜外麻醉与丙泊酚联合舒芬太尼全身麻醉对妇科腹腔镜手术患者呼吸、循环和动脉血气的影响。方法:选择行腹腔镜手术的妇科患者97例,按随机数字表法分为Ⅰ组(49例)和Ⅱ组(48例),Ⅰ组采用丙泊酚联合舒芬太尼全身麻醉,Ⅱ组采用罗哌卡因硬膜外麻醉,观察不同时间点两种方案对患者呼吸、循环和动脉血气的影响,并观察两组患者术后疼痛程度及并发症和不良反应发生情况。结果:Ⅰ组患者停药后清醒时间较Ⅱ组患者长,两组比较差异有统计学意义(P<0.05)。气腹后10、20 min时,Ⅰ组患者收缩压(SBP)、舒张压(DBP)、心率(HR)显著高于Ⅱ组患者,呼气末二氧化碳分压[pet(CO2)]显著低于Ⅱ组患者,两组比较差异均有统计学意义(P<0.05);术毕放气后10 min时,Ⅰ组患者SBP、HR仍显著高于Ⅱ组患者(P<0.05),Ⅱ组患者已恢复至接近麻醉前水平(P>0.05);两组患者在气腹后10、20 min及术毕放气后10 min时血氧饱和度(SpO2)比较,差异均无统计学意义(P>0.05);两组患者在气腹后20 min及术毕放气后10 min时动脉血二氧化碳分压[pbt(CO2)]比较,差异均有统计学意义(P<0.05)。Ⅱ组患者术后疼痛程度明显轻于Ⅰ组患者。两组患者均未见明显的麻醉相关并发症和不良反应发生。结论:罗哌卡因硬膜外麻醉可满足妇科腹腔镜手术需要,较采用丙泊酚联合舒芬太尼全身麻醉术后清醒时间更短,对血压及心率影响更小,术后疼痛程度更轻,且具有较好的安全性。

OBJECTIVE： To compare the effects of ropivacaine epidural anesthesia and propofol combined with sufentani general anesthesia on respiratory, circulation and arterial blood gas in patients underwent gynecology laparoscopic operation. METHODS： 97 patients underwent gynecology laparoseopie operation were collected and randomized into group Ⅰ （n=49） and group Ⅱ （n=-48）. Group I was given propofol combined with sufentanil general anesthesia, and group Ⅱ was given ropivaeaine epidural anesthesia. The effects of two scheme on respiratory, circulation and arterial blood gas were observed. The degree of pain, complication and ADR were observed in 2 groups after operation. RESULTS ： The awake time after drug withdrawal in group Ⅰ was significantly longer than in group Ⅱ ; there was statistical significance （P〈0.05）. SBP, DBP and HR of group Ⅰ were significantly higher than in group Ⅱ 10 min, 20 min after pneumoperitoneum, while the value of pet（CO2） was significantly higher than in group Ⅱ ; there was statistical significance （P〈0.05）. 10 min after postoperative air bleeding, SBP and HR of group Ⅰwere still higher than those of group Ⅱ significantly （P〈0.05） ; those of group Ⅱ recovered and were close to the level before anesthesia （P〉0.05）. There was no statistical significance in SpO2 between 2 groups 10 and 20 minutes after pneumoperitoneum and 10 min after postoperative air bleeding （P〉 0.05）. There was statistical significance in pbt（CO2） between 2 groups 20 minutes after pneumo- peritoneum and 10 min after postoperative air bleeding （P〈0.05）. The degree of postoperative pain in group 11 was significantly lesser than in group Ⅰ No obvious anesthesia-related compliance and ADR was found in 2 groups. CONCLUSIONS： Ropivacaine epidural anesthesia could meet the need of gynecological laparoscopic operation, and results in shorter postoperative awake time, less impact on BP and HR and lesser postoperative pain with better safety, compared with propofol combined with sufentani general anesthesia.