不同麻醉方法对腹腔镜子宫切除术病人气腹应激的临床观察

目的观察全麻复合硬膜外麻醉与单纯气管内全麻对腹腔镜子宫切除手术病人气腹应激的影响。方法对44例腹腔镜子宫切除术患者应用单纯气管内全麻（A组），并与同期44例全麻复合硬膜外麻醉患者（B组）进行比较。观察其对子宫切除术患者循环和皮质醇与醛固酮水平的影响。结果两组年龄、体重、ASA分级、并发症比较差异均无统计学意义（P〉0.05）。A组收缩压（SBP）、平均动脉压（DBP）、心率（HR）在气腹后明显高于人室麻醉后-术前稳定时水平（P〈0．05），尤其DBP、HR均高于B组同一时段的水平（P〈0．05）。而B组术中SBP、DBP 、HR均稳定于人室麻醉后-术前稳定时水平。A组在腹腔镜子宫切除术气腹后皮质醇、醛固酮水平较人室麻醉后．术前稳定时显著升高（P〈0．01），且显著高于B组（P〈0.05）。B组两者改变不显著（P〉0.05）。结论全麻复合硬膜外麻醉可通过有效阻断交感神经的传导通路，降低气腹对腹腔镜子宫切除术气腹应激的影响，保持皮质醇与醛固酮水平和循环功能稳定。

Clinical Observation of Abdominal Stress in Patients Treated with Laparoscopic Hysterectomy by Different Anesthesia

Objective To observe the effect on abdominal stress in laparoscopic hysterectomy patients by general anesthesia com- bined with epidural anesthesia or by simple endotracheal anesthesia. Methods The changes in circulation, hydrocortisone and aldosterone were observed in 44 patients by simple endotracheal anesthesia （Group A） and another 44 patients by general anesthesia Combined with epidural anesthesia （Group B）. There were no Significant differences between the two groups in age, body weight, ASA classification and complication （ P 〉 0.05 ）. Results In Group A, systolic blood pressure （ SBP）, digital blood pressure （DBP） and heart rate （HR） were significantly higher after aeroperitonia than during the time of anesthesia till operation （ P 〈 0.05 ）, and especially, DBP and HR of Group A were higher than that of Group B at the same time （ P 〈 0.05 ）. Hydrocortisone and aldosterone in Group A were significantly higher after aeroperitonia than during the time between anesthesia and surgery （ P 〈 0.01 ） , and were significantly higher than that in Group B （ P 〈 0.05 ）. But the two parameters were not significantly changed in Group B （ P 〉 0.05 ）. Conclusion The passageway of conduction may be obstructed by general anesthesia combined with epidural anesthesia, which may cut down the effect of abdominal stress and maintain the stabilization of hydrocortisone, aldosterone and circulation function in laparoscopic hysterectomy.