不同麻醉方案对腹腔镜手术患者血浆皮质醇的影响

目的研究不同麻醉方案对经腹腔镜行胆囊切除术（LC）患者血浆皮质醇的影响，发现全麻插管＋硬膜外麻醉更适合LC的麻醉方案。方法选择ASAⅠ～Ⅲ级择期行LC患者20例随机分为全麻组（G组，n=10）和全麻＋硬膜外麻醉组（GE组，n=10）两组。G组患者给予芬太尼0．5μg/kg、异丙酚1～2m/kg、卡肌宁0．6mg／kg诱导插管，术中给予卡肌宁维持肌松；GE组患者在选择T8-9行硬膜外穿刺置管，后行全麻插管，诱导药物剂量及麻醉机参数调节同G组，术中硬膜外给予0．5％罗哌卡因＋1％利多卡因镇痛。两组均静脉给予丙泊酚微泵静推维持麻醉深度。分别于麻醉后切皮前（L），腹腔充气后即刻（T2），腹腔充气后30min（B），放气后10min（T4）及24h（B）5个时点抽血检测患者的血糖及皮质醇水平，同时记录各时点血压（MAP）、心率（HR）的变化、各组麻醉药物的用量、苏醒时间、麻醉费用及住院时间。结果两组患者均选择同一手术组医生完成手术，且术前一般情况及手术时间等差异无显著性（P〉0．5）；除L和B外，G组其他时点MAP、HR均较GE组要显著增高（P〈0．05）；同时，除L外，其他各时点的血浆皮质醇含量及血糖也是G组较GE组要显著升高（P〈0．05）；GE组丙泊酚及芬太尼用量则较G组要明显减少（P〈0．05），且患者术后苏醒的时间也较G组明显要短（P〈0．05）；同时并不增加患者的麻醉费用及住院时间（P〉0．5）。结论全麻插管＋硬膜外麻醉对于经腹腔镜行胆囊切除术患者血浆皮质醇影响较单纯全麻插管麻醉要显著减轻，是更适合该类手术的麻醉方案。

Influence of Different Anesthetic Plans on the Concentration of Plasma Cortisol of the Patients Undergoing Laparoscopic Cholecystectomy

Objective To investigate the influence of different anesthetic plans on the concentration of plasma cortisol of the patients undergoing laparoscopic cholecystectomy （LC）, and determine the better anesthetic plans for those patients. Methods Twenty adult ASA Ⅰ～Ⅲ patients scheduled for LC were randomly divided into general anesthesia group （Group G, n=10） and general anesthesia combined with epidural anesthesia group （group GE, n = 10）. The patients in group G were induced with： fentanyl 0.5 μg/kg, propofol 1 - 2 mg/kg atracurium 0.6 mg/kg, and maintained muscle relaxation with intermittent intravenous atracurium. After inserted epidural catheters at T8-9, the patients in group GE were induced with the same drugs as those in group G, and administrated 0.5% ropivacaine mixed with 1% lidocaine for analgesia through the epidural catheters during operations. Both groups were continual intravenous infused with propofol to maintain the anesthesia depth. The venous blood samples were withdrawn at the following time points： before operation （T1）, the moment of CO2 insufflated into peritoneal cavity （T2）, 30 minutes after CO2 insufflated （T3）, 10 minutes （T4） and 24 hours （T5） after CO2 released to measure the concentration of plasma cortisol and glucose. Mean arterial pressure （MAP） and heart rate （HR） of each time point, the amount of the anesthetic agents used, the awaken time and the expense of anesthesia and overall hospital duration were recorded. Results The operations of both groups were operated by the same team of doctors, and there were no signally difference in pre-operation conditions and the duration of operations in both groups （ P 〉 0.05 ）. MAP and HR were significantly higher in group G than those in group GE, except T1 and T5 （P〈0.05）. Compared with group GE, the concentration of plasma cortisol and glucose was increased significantly in group G, except T1 （P〈0.05）. Less amount of fentanly and propofol used, the shorter awaken time taken