不同麻醉方法对腹腔镜胆囊切除术围术期胃肠动力的影响

目的 :比较不同的麻醉方法对腹腔镜胆囊切除术 (LC)患者围术期胃肠动力的影响。方法 :4 2例行LC患者随机分成硬膜外复合全身麻醉组 (A组 ) ,异丙酚全凭静脉麻醉组 (B组 ) ,异氟醚吸静复合全身麻醉组 (C组 ) ,每组14例。分时段监测血浆胃动素变化 ,观察术后 4 8h内恶心呕吐发生率及肛门首次排气时间 ,并记录术后住院日。结果 :① 3组病人胃动素术毕均较术前、术后 2 4h ,4 8h明显升高 (P <0 .0 5 ) ,术后 4 8h恢复到术前水平 ;其中C组术毕时胃动素明显高于A ,B两组 (P <0 .0 5 )。②术后 6h内恶心呕吐的发生率C组明显高于A ,B两组 (P <0 .0 5 ) ,术后6h后差异无显著性 (P >0 .0 5 )。③术后 3组病人肛门首次排气时间及术后住院日无明显差别 (P >0 .0 5 )。结论 :不同的麻醉方法不会影响LC手术围术期肛门首次排气时间的恢复及术后住院日的长短 ;硬膜外复合全麻及异丙酚全凭静脉麻醉术后的恶心呕吐发生率较低 ,是较理想的麻醉选择

Effect of different anesthesias on gastrointestinal motility after laparoscopic cholecystectomy

Objective To compare the effect of three different anesthesias on gastrointestinal motility after laparoscopic cholecystectomy (LC). Methods Forty two patients undergoing LC were randomly allocated to the combined epidural general anesthesia group (Group A,n=14), propofol based total intravenous anesthesia group (Group B, n=14) and isoflurane based inhalational intravenous general anesthesia group (Group C,n=14). The concentration of plasma motilin was measured; the incidence of postoperative nausea and vomiting and the first flatus time were observed; and the in hospital day was recorded. Results ① The concentration of plasma motilin increased significantly during the first 1 h postoperatively (P<0.05), but it had no significant difference in the 48 h after operation (P>0.05) in comparison with the preoperative data in the three groups. The concentration of plasma motilin in Group C was much higher than that in the other two groups during the first 1 h postoperatively (P<0.05). ② The incidence of postoperative nausea and vomiting was much higher in Group C than that in the other two groups during the first 6 h postoperatively (P<0.05), but there was no significant difference in the 6 h after operation in the three groups (P>0.05).③ The first flatus time and in hospital day postoperatively had no statistical difference in the three groups (P>0.05). Conclusion Different anesthesias do not influence the recovery of intestinal motion and in hospital day postoperatively; the combined epidural general anesthesia and propofol based total intravenous anesthesia may be ideal anesthesias because of the lower incidence of postoperative nausea and vomiting.