儿童腹腔镜精索静脉结扎术硬膜外麻醉和全身麻醉的比较

目的比较硬膜外麻醉和气管插管全身麻醉在儿童腹腔镜精索静脉结扎术中的应用效果。方法按可比条件选择40例在泌尿外科择期行手术的儿童,依家长对麻醉方式的要求及医生的选择,分为硬膜外麻醉组(E组,n=20)和气管插管全身麻醉组(I组,n=20)。对比观察2组患儿麻醉及术后恢复过程。结果2组患儿的麻醉诱导和维持满意,术中未出现体动,术后无知晓。2组患儿的术中血压、pH、SpO2均无明显变化。E组患儿气腹后、停气腹后心率明显减慢(P<0.05),呼吸频率明显加快(P<0.05),PaCO2、HCO3-均明显升高(均P<0.05)。I组的心率、呼吸、PaCO2、HCO3-均无明显改变。结论ASAⅠ级的患儿行类似腹腔镜精索静脉结扎术类的短时手术,在1.6kPa(12mmHg)气腹压力下,选择硬膜外麻醉是安全可行的。

Epidural Anesthesia Versus Inhalation Anesthesia for Laparoscopic Varicocelectomy in Children

Objective To compare the adverse effects in between epidural and general anesthesia for laparoscopic varicocelectomy（LV）, to explore the feasibility of epidural anesthesia in short procedures to meet the preference of some mothers and surgeons.Methods A prospective study was made in 40 cases randomly selected from two matchable groups of children, 20 from each group, who come for LV under either epidural anesthesia（group E） or inhalation anesthesia（group I） according to the preference of anesthetists and mothers. The followings are recorded including: anxiety of induction, smoothness during operation, intubation time, postoperative pain and recovery of eating and walking. During anesthesia, the HR, MAP, SpO₂, P_ET CO₂（group I）, Ppeak（group I）and RR（group E）were recorded continuously. Arterial blood gas analyses were done at definite time: 5 min before pneumoperitoneum, 5 min and 15 min after pneumoperitoneum and 5 min after decompression of pneumoperitoneum.Results 1) General comparisons were made on the smoothness of operation, pre-and post-operative reaction and recovery; there was no significant difference between the two groups of anesthesia. 2) In the group E, compared with the HR before pneumoperitoneum, the HR was significantly lowered 15 min after pneumoperitoneum and 5 min after decompression of pneumoperitoneum（ P <0.05）; while the HR showed no marked change before and after pneumoperitoneum in the Group I（ P >0.05）. 3) the respiratory rate（RR） in the group E remarkably increased after pneumoperitoneum（ P <0.05）and remained at a high level at 5 min after decompression of pneumoperitoneum. 4) Arterial blood gas: the PaCO₂ and HCO₃ - were significantly elevated after pneumoperitoneum in group E.Conclusion Although inhalation anesthesia is superior in the reversibility, and the blood gas analyses showed also better records, but clinically the adverse effects were negligible in epidural anesthesia. For patients of ASAⅠgrade undergoing minor operations like LV less than 40 min and pneumoperitoneum pressure of 1.6 kPa（12 mmHg）, epidural anesthesia is definitely safe and feasible.