不同麻醉方法在腹腔镜手术中的临床对比研究

目的旨在对比分析连续硬膜外麻醉、静吸全身麻醉及硬膜外阻滞复合静吸全身麻醉三种不同麻醉方法应用于腹腔镜胆囊切除术的麻醉效果、安全性及意义。方法收集拟行腹腔镜下胆囊切除术患者120例,将其随机分为连续硬膜外麻醉组(A组)、静吸全身麻醉组(B组)和硬膜外阻滞复合静吸全身麻醉组(C组),各40例。比较三组手术时间、并发症和麻醉效果及麻醉前、麻醉后、气腹后及术毕时的心率(HR)、平均动脉压(MAP)和呼气末二氧化碳分压(PETCO2)等,同时比较B组和C组术毕停药后至自主呼吸恢复、苏醒、定向力恢复时间。结果三组麻醉后10min血压显著下降和心率显著增快且与麻醉前5 min对比差异有统计学意义(P<0.05);术后C组苏醒时间显著少于B组(P<0.05);C组拔出气管插管时间显著少于B组(P<0.05);A、B和C三组的优良率分别为87.5%、90.0%和100.0%,C组显著优于A组和B组(P<0.05)。结论硬膜外阻滞复合静吸全身麻醉具有麻醉药物用量少、呼吸循环功能稳定、苏醒快、不良反应少及安全性高等特点,可广泛应用于腹腔镜胆囊切除术麻醉。

Comparative study of different anesthesia techniques in laparoseopic cholecystectomy

Objective To compare the anesthetic effect,security and significance of epidural anesthesia,general anesthesia and combined epidural anesthesia with general anesthesia used in the laparoscopic cholecystectomy.Methods 120 patients who underwent lower laparoscopic cholecystectomy were randomly divided into epidural anesthesia group（group A）,general anesthesia group（group B） and combined epidural anesthesia with general anesthesia group（group C）,40 patients of each group.The operative time,complications and anesthetic effect and HR,MAP and PETCO2 before anesthesia,anesthesia,pneumoperitoneum and after surgery of the three groups of patients were compared.Also the completion of withdrawal to breathing on his own recovery,waking up,disorientation recovery between group B and group C were compared.Results The blood pressure of three groups after anesthesia 10 min were significantly decreased and the heart rate were significant ly faster than that before anesthesia 5 min（P〈0.05）;the time of waking up of group C was significantly less than group in group B（P〈0.05）;the time of pull out the intubation of group C was significantly less than that in group B（P〈0.05）;the excellent rate of group A,B,and C was 87.5%,90.0% and 100.0%,the excellent rate of group C was significantly better than group A and group B（P〈0.05）.Conclusion The epidural anesthesia combined with general anesthesia have many advantages,such as less narcotic drugs,the stability of the respiratory and circulatory function,rapid recovery,fewer ad verse reactions and high security,etc.It can be widely used in laparoscopic cholecystectomy anesthesia.