不同麻醉方法用于腹腔镜胆囊切除术的临床观察

目的:观察全麻与全麻复合硬膜外麻醉用于腹腔镜胆囊切除术(LC)时的血流动力学、呼气末二氧化碳分压(PetCO2)和术毕清醒质量的影响.方法:40例LC患者随机分为全麻组(A组,n=20)和全麻复合胸段硬膜外麻醉组(B组,n=20),连续监测SBP、DBP、MAP、HR、ECG、SpO2、BIS、PetCO2,记录两组患者麻醉前(T1)、插管后(T2)、气腹后10min(T3)、气腹后20min(T4)和放气后10min(T5)的SBP、DBP、MAP、HR、PetCO2,以及全麻用药量和拔管时间.结果:在T2、T3、T4、T5时,A组SBP、DBP、MAP值明显升高,B组较基础值下降,组间差异显著(P＜0.05);气腹期间A组心率明显升高(P＜0.05),B组无明显变化(P＞0.05);气腹20min后PetCO2值两组都较术前升高,以A组明显(P＜0.05);组间比较差异显著(P＜0.05);术毕拔管时间B组较A组时间明显缩短(P＜0.05).结论:LC时,全麻复合胸段硬膜外麻醉使循环、呼吸更稳定,清醒质量高;术中需加强PetCO2的检测,尤其是气腹解除后.

Clinical research of application of different types of anesthesia in laparoscopic cholecystectomy

Objective：To compare PETCO2 and hemodynamic change in laparoscopic cholecystectomy（LC） under general anesthesia and general-epidural combined anesthesia.Methods：40 patients of LC were divided into general anesthesia group（A group,n=20） and general-thoracic epidural anesthesia group（B group,n=20） randomly.All patients’SBP,DBP,MAP,HR,ECG,SpO2,BIS and PetCO2 were monitored continuously.To record SBP,DBP,MAP,HR,PetCO2 before anesthesia,after tracheal intubation,at 10min,20min after pneumoperitoneum and at 10min after the removal of pneumoperitoneum,extubation time and drug consumption of fentanyl and propofolwere observed.Results：After tracheal intubation,at 10min,20min after pneumoperitoneum and at 10min after the removal of pneu-moperitoneum,SBP,DBP,MAP in group A increased significantly than those in group B（P〈0.05）.During pneumoperitoneum,HR wereincreased significantly in group A（P〈0.05）.On the contrary,there was no change in group B（P〈0.05）,at 20min after pneumoperitoneumPetCO2 was increased significantly between group A and group B,especially group A（P〈0.05）,there was difference between two groups（P〈0.05）.The time of extubation was shorter comparatively in group B（P〈0.05）.Conclusion：The respiration and hemodynamic changesare slighter during LC under general-thoracic epidural anesthesia than general anesthesia,furthermore,the recovery quality is better.Anesthetists should strengthen the detection of PetCO2,especially after the removal of pneumoperitoneum.