两种不同硬膜外麻醉方式对胆囊切除术患者麻醉效果的对比研究

目的 探讨两种不同硬膜外麻醉方式对胆囊切除术患者麻醉效果.方法 将胆囊疾病患者86例,按数字法随机分为硬膜外麻醉组（对照组,n=43）和硬膜外复合静脉麻醉组（观察组,n=43）,进行麻醉方式的效果研究.结果①两组间手术前指标包括皮质醇、肾上腺素及血糖浓度检测值比较差异无统计学意义（P＆gt;0.05）;手术后10 min,研究组患者的肾上腺素、皮质醇及血糖监测值浓度均显著低于对照组（P＜0.05）.②患者86例手术过程顺利均获成功,患者术后住院时间为5～10 d,平均住院时间（7.2＆#177;0.8）d.研究组术中失血量较对照组明显减少（t=3.814,P＜0.05）,手术时间较对照组明显缩短（t=2.128,P＜0.05）.③研究组患者37例（86.05%）术后第2日下床活动,无术中胆道损伤发生,且无术后腹腔出血、漏胆、伤口感染等情况发生;对照组患者34例（79.07%）术后第2日下床活动,无术中胆道损伤,术后无腹腔出血、漏胆发生,术后伤口感染发生1例,经积极抗感染后痊愈.结论 硬膜外复合静脉复合麻醉具有麻醉效果较好、患者生命体征稳定、应激反应较为平和的优点,增加了手术及麻醉过程的安全系数,明显优于单纯硬膜外麻醉,因此较适合基层医院开展腹腔镜手术中应用.

A comparative study on efficacy of two kinds of epidural anesthesia for patients undergoing cholecystectomy

Objective To explore the effect of two different kinds of epidural anesthesia for patients undergoing cholecystectomy. Meth- otis Eighty six patients with gallbladder disease in department of general surgery of this hospital during March 2006 to February 2010 were ran- domly divided into epidural anesthesia group （ control group, n = 43 ） and combined epidural and intravenous anesthesia group （ observation group, n = 43 ） , and the effect of anesthesia in these groups had been compared. Results （~）Tbe three indicators of adrenaline, cortisol and blood glucose concentration were compared between these 2 groups before operation, their difference was not statistically significant （ P 〉 O. 05 ）. The monitoring values of adrenaline, cortisal and blood glucose concentration in patients of observation group were significantly lower than those of control group （ P 〈0.05 ）. All these 86 patients were successfully operated, postoperative hospitalization time of patients was 5 ~ 10 d, with av- erage length of 7.2 ＋ O. 8 d. The intraoperative blood loss in observation group was obviously less than that of control group （ t = 3.814, P 〈 O. 05）, and the operating time was significantly shorter （ t =2. 128, P 〈0.05 ）. 37 patients （86.05%） of observation group could ambulate at second postoperative day, and no intraoperative bile duct injury occurred, and no postoperative intra - abdominal bleeding, bile leakage and wound infection occurred. 34 patients in control group （79.07%） could ambulate at second day after operation, no intraoperative bile duct injury, no postoperative bleeding in abdominal cavity and bile leakage occurred, but postoperative wound infection occurred in 1 case, and he had been recov- ered after active anti - inflammatory treatment. Conclusion The effect of combined epidural and intravenous compound anesthesia is good, and the vital signs of patients under anesthesia are stable, with relatively flat and stress response, and the safety of operation and anesthesia process had been increased, these are significantly better than those with simple epidural anesthesia, therefore it is suitable for application in peritoneoscopic operation.