两种麻醉方法下CO_2气腹对冠心病Q-T离散度的影响

Effects of CO_2 pneumoperitoneum on Q-T disperity of coronary artery disease after different anesthesia

目的 :观察两种麻醉方法下冠心病患者行腹腔镜胆囊切除术 (LC)术中CO2 气腹对Q -Td的影响。方法 :择期行LC手术 ,ASAⅠ级～Ⅲ级患者 4 0例 ,随机分为无冠心病硬膜外组、冠心病硬膜外组、冠心病全麻组、无冠心病全麻组 4组 ,硬膜外组用 0 5 8%布比卡因作局麻药 ,全麻组常规快诱导插管 ,分别测出气腹前、气腹后 15min、 2 0min时的Q -Tmin、Q -Tmax、Q -Tcd及HR、MAP、RPP进行比较。结果 :冠心病硬膜外组和全麻组气腹后 2 0min时QTcd延长、RPP值下降较气腹前有明显差异 ,P <0 0 5。结论 :推测冠心病患者LC手术中冠脉血流量明显减少 ,CO2 气腹是LC手术中的重要影响因素 。

Objective:To investigate the effects of CO 2 pneumoperitoneum on Q-T disperity during laparoscopic cholecystomy(LC)in patients with coronary artery disease(CAD)after different anesthesia.Methods:Forty ASAⅠ-Ⅲ patients were randomly divided into 4 groups: normal continous epidural anesthesia(CEA)group(group A),CAD with CEA group(group B),CAD with general anesthesia group(group C)and normal general anesthesia group(group D).Bupibacaine was used as the local anesthesia drug in group A and B.Midozolam,fentanyl and scoline were used for induced intuation of general anesthesia in group C and D.Q-T min ,Q-T max ,Q-T cd ,HR,MAP,and RPP were all recorded before pneumoperitoneum,and 15 minutes and 20 minutes after pneumoperitoneum.Results:Compared with that before pneumoperitoneum,Q-T was longer and RPP decreased significantly(P<0.05)20 minutes after pneumoperitoneum in group B,C and D.Conclusion:It can be concluded that the volume of blood flow in coronary artery decreases because of CO 2 pneumoperitoneum,which gives rise to the prolonging of Q-T.Therefore,CO 2 pneumoperitoneum is an important influence factor of Q-T desperity in LC,and there is no direct relation between anesthesia and Q-T disperity.