不同全身麻醉方式在腹腔镜手术中应用效果的比较

Application effect comparison of different general anesthesia mode in la-paroscopic surgery

目的 比较不同全身麻醉方式在腹腔镜手术中的应用效果。方法 2013年3月-2015年2月,选择下腹部腹腔镜手术患者90例,ASAⅠ-Ⅱ级,相同麻醉方案诱导后,按照不同的全身麻醉维持方式,将患者分为3组：全凭丙泊酚静脉麻醉组（A组）、全凭异氟醚吸入麻醉组（B组）以及丙泊酚、异氟醚静吸复合麻醉组（C组）。记录气腹前（T0）、气腹时（T1）、气腹后15 min（T2）、术毕时（T3）、拔管时（T4）、拔管后5 min（T5）的MAP和HR;记录苏醒时间、拔管时间、苏醒期躁动发生率以及术后不良反应发生情况;记录拔管时（T4）、拔管后5 min（T5）、拔管后10 min（T6）、拔管后20 min（T7）的OAA/S评分。结果 T0、T1、T2、T3时,3组的MAP、HR差异无统计学意义（P〉0.05）;与T0时比较,T1、T2时,3组的MAP明显升高,HR明显增快（P〈0.05）;与A组比较,T4、T5时,B、C组的MAP、HR明显升高（P〈0.05）。A组术毕苏醒时间、拔管时间明显短于B、C组（P〈0.05）;A、C组的苏醒期躁动、恶心呕吐、呛咳发生率明显低于B组（P〈0.05）,且A组明显低于C组（P〈0.05）;T5、T6时,A组的OAA/S评分明显高于B、C组（P〈0.05）。结论 全凭丙泊酚静脉麻醉用于下腹部腹腔镜手术,术中血流动力学平稳,术毕苏醒快、质量高,苏醒期躁动及其他不良反应少。

Objective To compare the application effect of different general anesthesia modes in laparoscopic surgery.Methods From March 2013 to February 2015,90 patients with ASAⅠ-Ⅱ grade received with laparoscopic surgery of lower abdomen were selected.After they were induced by the same anesthetic regimen and divided into 3 groups：total intravenous anesthesia of propofol group（group A）,total inhalation anesthesia of isoflurane group（group B） and propofol by intravenous anesthesia combined with isoflurane inhalation anesthesia group（group C） according to maintained method with different general anesthesia.Mean arterial pressure（MAP） and heart rate（HR） before pneumoperitoneum（T0）,during pneumoperitoneum（T1）,after 15 min pneumoperitoneum（T2）,termination of surgery（T3）,when extubation（T4）,and after 5 min extubation（T5） were recorded.Awakening time,time of extubation,incidence rate of restlessness during awakening period and postoperative occurrence of adverse reaction were recorded. OAA/S score was recorded in T4,T5,after 10 min extubation（T6）,and after 20 min extubation（T7） were also recorded. Results There was no statistical difference of MAP or HR at T0,T1,T2, and T3 among 3 groups（P〉0.05）.In comparison with T0,MAP was greatly increased at T1 and T2in 3 groups and HR was obviously quickened（P〈0.05）.Compared with group A,MAP and HR were greatly increased in group B and group C at T4 and T5（P〈0.05）.In group A,time of awakening after surgery and time of extubation were significantly shorter in comparison with that in group B and C respectively（P〈0.05）.Incidence rate of restlessness,nausea and vomiting,and cough in group A and group C was obviously lower than that in group B respectively（P〈0.05）,and those in group A was the lowest（P〈0.05）.The OAA/S score in group A at T5 and T6were remarkably higher than that in group B and group C respectively（P〈0.05）. Conclusion Total propofol intravenous anesthesia for lower abdominal laparoscopic surgery has advantage of intraoperative stable hemodynamics,quick awakening after surgery with high quality,and few restlessness during awakening period and other adverse reaction.