硬膜外麻醉与全麻在妇科腹腔镜手术中的应用

目的比较气管插管全身麻醉（G）和持续性硬膜外腔阻滞麻醉（E）在妇科腹腔镜手术中的麻醉安全性及应激反应。方法选择我院2009年7月～2010年12月200例妇科腹腔镜手术患者,其中100例手术采用气管插管全麻方式,另100例采用持续硬膜外麻醉方式。两组患者麻醉后,持续监测平均动脉压（MAP）、心电图（ECG）、血氧饱和度（SpO2）、心率（HR）和呼气末二氧化碳分压（PetCO2）。记录两组患者CO2气腹前（T0）,气腹后5min（T1）、15min（T2）、30min（T3）及停气后10min（T4）的MAP,HR,SpO2以及术后苏醒时间（Tw）及此过程中的血糖变化情况。结果 E组T1、T2,HR明显降低（P〈O.05）,30min恢复到气腹前水平,G组气腹后HR无明显变化（P〉0.05）,两组比较差异无统计学意义。气腹后G组MAP显著升高（P〈0.05）,至停气后10min尚未恢复到气腹前水平,而E组整个气腹期间MAP无明显变化或略低（P〉0.05）,与G组比较差异有统计学意义（P〈O.05）;T3及T4 G组血糖升高显著高于E组。结论硬膜外麻醉可安全用于短时间的妇科腹腔镜手术,并且硬膜外麻醉能够减轻手术引起的应激反应。

Comparison the continuous epidural anesthesia with general anesthesia in gynecological laparoscopic surgery

Objective To compare the general anesthesia（G） with continuous epidural anesthesia（E） in gynecological laparoscopic surgery＇s anesthesia safety and stress response.Methods 200 laparoscopic surgery patients in the chengdu fifth hospital from July 2009 to December 2010 were enrolled in,and 100 cases were enclosed to G group（the general anesthesia）,the other 100 cases to E group（continuous epidural anesthesia）.During five time scales： before C02 pneumoperitoneum（T0）,after pneumoperitoneum 5 min（T1）,15 min（T2）,30 min（T3） and after stopping pneumoperitoneum 10 min（T4）,we continuously monitored mean arterial pressure（MAP）,electrocardiogram（ECG）,oxygen saturation（SpO2）,heart rate（HR） and end-tidal carbon dioxide partial pressure（PetC02）.Results E group＇s HR in T1（after pneumoperitoneum 5 mins） and T2（after pneumoperitoneum 15 mins） was significantly less than G group（P0.05）.G group＇s MAP after pneumoperitoneum was significantly higher than E group（P0.05） and after stopping pneumoperitoneum 10 mins MAP has not been restored to the level before pneumoperitoneum.E group＇s MAP was no significant changes throughout the pneumoperitoneum period（P 0.05）,and comparison to G group there was significant difference（P0.05）.Conclusion Epidural anesthesia is safe for a short period of laparoscopic surgery,and epidural anesthesia can reduce the stress caused by surgery.