不同麻醉方法用于妇科腔镜手术的临床效果观察

Clinical Effect of Different Anesthesia Methods for Gynecological Laparoscopic Operation

目的在妇科腹腔镜手术中,比较应用不同麻醉方法对患者循环、呼吸、血气的影响。方法选择2011年2月—2014年2月择期拟行腹腔镜手术的300例患者,随机分为行腰-硬联合麻醉的A组和行静脉复合麻醉的B组,每组均为150例。连续监测患者在麻醉前、手术10 min、术后10 min的心率(HR)、呼吸(R)、平均动脉压(MAP)、血氧饱和度(Sp O2)等指标,并在麻醉前、气腹后10 min时以及术后10 min时检测患者的动脉血气。结果两组在麻醉前HR、R、MAP、Sp O2等指标未见明显差异;在手术10 min时A组HR、R、MAP较麻醉前有显著的下降(P<0.05),但在术后10 min恢复至麻醉前范围;而B组在手术10 min时、术后10 min,各指标较麻醉前变化不大(P>0.05)。在气腹10 min后,A组p H值较麻醉前显著降低、二氧化碳分压(Pa CO2)值较麻醉前显著升高,氧分压(Pa O2)较麻醉前降低(P<0.05);在气腹10 min后,B组Pa CO2值较麻醉前显著升高,但是却显著低于同时间A组Pa CO2值水平,Pa O2值显著低于麻醉前,显著高于A组,差异均有统计学差异(P<0.05)。结论腰-硬联合麻醉与静脉复合麻醉两种麻醉措施均可用于妇科腹腔镜手术,而静脉复合麻醉对呼吸、循环的影响较小。

Objective To compare the influence of different anesthesia methods during gynecological laparoscopic surgery on circulation,respiration and blood gas of patients. Methods A total of 300 patients undergoing laparoscopic surgery during February 2011 and February 2014 were randomly divided into group A（ n = 150） and group B（ n = 150）.Group A received combined spinal epidural anesthesia,and group B was given balanced anesthesia. The values of patients＇ heart rate（ HR）,respiration（ R）,mean arterial pressure（ MAP） and arterial oxygen saturation（ Sp O2） were under continuous monitoring before anesthesia,intraoperative 10^th min and postoperative 10^th min,and the values of arterial blood gas were detected before anesthesia,at 10^th min after pneumoperitoneum and 10^th min after operation. Results There were no significant differences in values of HR,R,MAP and Sp O2 in the two groups before anesthesia; the values of HR,R and MAP intraoperative 10^th min were significantly decreased than those before anesthesia（ P〈0. 05）,but the values retuned to preanesthesia levels at 10^th min after operation; but in group B,the indexes were somewhat changed before anesthesia compared with those intraoperative 10^th min and postoperative 10^th min（ P〉0. 05）. At 10 min after pneumoperitoneum in group A,p H value was significantly decreased,while partial pressure of carbon dioxide（ Pa CO2） value was significantly increased,and oxygen partial pressure（ Pa O2） value was significantly decreased compared with those before anesthesia（ P〈0. 05）; At 10 min after pneumoperitoneum in group B Pa CO2 value was significantly increased before anesthesia,but the value was significantly lower than that of group A at the same time; while Pa O2 value was significantly lower before anesthesia,but the value was significantly higher than that of group A,and there were statistically significant differences（ P〈0. 05）. Conclusion Both combined spinal epidural anesthesia and the balanced anesthesia can be administrated for gynecological laparoscopic surgery,but the balanced anesthesia has less effect on respiration and circulation.