硬膜外联合全麻在腹腔镜下腹部手术中的临床观察

Epidural Anesthesia Combined Laparoscopic Abdominal Surgery in the Clinical Observation

目的观察硬膜外阻滞复合气管插管全麻和单纯气管插管全麻对腹腔镜下腹部手术中应激反应的影响,术中全麻药用量及苏醒时间。方法 40例行腹腔镜患者,其中直肠癌10例,子宫全切30例,随机分成全麻组(A组,20例)和硬膜外复合全麻组(B组,20例),持续监测MAP、HR,静脉全麻药用量,苏醒时间、拔管时间、PICU停留时间。结果气腹时MAP、HR,A组均明显增加(P<0.05),B组无明显变化(P>0.05);静脉全麻药用量A组>B组;苏醒时间A组>B组,拔管时间A组>B组,PICU停留时间A组>B组。结论硬膜外复合全麻可有效抑制腹腔镜下腹部手术中的应激反应,减少静脉全麻药用量,苏醒快,在PICU停留时间短的优点,值得临床推广和应用。

Objective To explore the inlfuence of the epidural anesthesia compound endotracheal intubation anesthesia and pure endotracheal intubation anesthesia on the stress reaction in laparoscopic abdominal surgery, intraoperative general anesthetics dosage and awakening time.Methods 40 cases of laparoscopic patients including 10 cases of rectal cancer, 30 cases of all uterus cut, were randomly divided into two groups. Group A was general anesthesia （20 cases）. Group B was compound epidural anesthesia （20 cases）. Monitoring continuously MAP, HR, dosage of intravenous anesthetics, awakening time, extubation time, PICU residence time.Result Group B was better than group A, there was statistical signiifcance of MAP and HR. Group A was signiifcantly increased （P＆lt;0.05）, the group B was no obvious change （P＆gt;0.05） in the pneumoperitoneum. Intravenous anesthetics dosage （group A＆gt;group B）; the time of wakening （group A＆gt;group B）; the time of decannulation （group A＆gt;group B）; the PICU residence time （group A＆gt;group B）.Conclusion The compound epidural anesthesia can effectively restrain stress reaction of laparoscopic abdominal surgery, reduce the dosage of intravenous anesthetics, it has advantages of fast wakening and short PICU residence time, worthy of clinical popularization and application.