不同麻醉方式对妇科腹腔镜手术患者血流动力学影响的比较研究

目的:比较不同麻醉方式下腹腔镜妇科手术中二氧化碳气腹前后血流动力学变化和血儿茶酚胺、皮质醇和血气的变化。方法:患者90例随机分为腰硬联合组(Ⅰ组)、全麻组(Ⅱ组)和硬膜外复合全麻组(Ⅲ组)各30例。术中连续监测,分时段测定血气及血肾上腺素(E)、去甲肾上腺素(NE)及皮质醇(COS)浓度。比较3组间的差异。结果:与气腹前比较,气腹时Ⅰ组HR和BP均明显减少(P<0.05);Ⅱ组HR和BP均明显增加(P<0.05);Ⅲ组各指标无明显变化(P>0.05)。气腹时3组PaCO2、HCO3-均明显增高(P<0.05),但3组间各指标无明显差异(P>0.05)。与麻醉前比较,E、NE及COS浓度,气腹时Ⅱ组有明显差异(P<0.05);Ⅲ组无明显变化(P>0.05)。结论:3种麻醉均可应用于妇科腹腔镜手术,但Ⅲ组在控制患者血压、维持良好的血气状态减轻机体应激反应等方面优于Ⅰ、Ⅱ组。

Comparison of the influence of different anesthesia methods on hemodynamic indexes in gynecological patients undergoing laparoscopic surgery

Objective: To compare hemodynamic changes and blood catecholamine,cortisol and blood-gas variations before and after carbon dioxide pneumoperitoneum during gynecological laparoscopic surgery under different anesthesia.Methods:A total of 90 patients were randomly divided into combined spinal epidural anesthesia group(Group Ⅰ),general anesthesia group(Group Ⅱ) and epidural anesthesia group(Group Ⅲ),with 30 patients in each group.Continuous monitoring was carried out and the level of blood-gas,epinephrine(E),norepinephrine(NE) and cortisol(COS) were measured respectively at different time for comparison.Results:During pneumoperitoneum,the HR and BP in Group Ⅰ decreased remarkably(P<0.05),while that in Group Ⅱ increased obviously(P<0.05) and none of those indicators in Group Ⅲ had significant changes(P>0.05).Though PaCO2 and HCO3in all groups rose remarkably during pneumoperitoneum period(P<0.05),there is no significant difference between those indicators among three groups(P>0.05).The level of E,NE and COS in Group Ⅱ showed significant differences during pneumoperitoneum period(P<0.05),while no significant changes were observed in Group Ⅲ(P>0.05).Conclusion:Although all the three anesthesia methods can be applied in gynecological laparoscopic surgery,epidural anesthesia is better than the other two methods in aspects such as controlling BP,maintaining fine blood-gas situation and alleviating stress response.