三种麻醉方法对腹腔镜胆囊切除术应激反应及血气的影响

目的 观察全麻、硬膜外麻醉和全麻复合硬膜外麻醉下行腹腔镜胆囊切除术中应激反应及血气的变化.方法 60例行腹腔镜胆囊切除术患者,随机分为全麻组(G组)、硬膜外麻醉组(E组)和全麻复合硬膜外麻醉组(G E组),分别测定麻醉前、气腹前、气腹后30分的心率(HR)、平均动脉压(MBP)的变化,并于上述后两个时点采集动脉血测定去甲肾上腺素(NE)、血糖浓度及血气分析(PH、PCO2、BE).结果 (1)G组在气腹后30分时HR、BP均较E组和E G组高,相比有显著性差异.(2)G组和E组在气腹后30分时测定NE与血糖较气腹前升高,相比有显著性差异;E G组在气腹后30分时测定NE与血糖和气腹前相比无显著性差异;G组、E组与G E组相比有显著性差异.(3)E组在气腹后30分时测定PaCO2较气腹前增加,相比有显著性差异,与G组和G E组在上述时点相比有显著性差异;G组和G E组在气腹后30分时测定PaCO2较气腹前增加不显著,相比无显著性差异.结论 全麻复合硬膜外麻醉下行腹腔镜胆囊切除术可有效消除气腹及手术引起的心血管及应激反应,且可预防CO2在体内的蓄积.

Stress response and blood gas changes during laparoscopic cholecystectomy under epidural block,general anesthesia and combined general epidural anesthesia

Objective To compare the stress response and blood gas changes during laparoscopic cholecystectomy (LC) under epidural block, general anesthesia and combined general epidural anesthesia. Methods sixty patients undergoing LC were divided into epidural block group (group E n=20), general anesthesia group (group G n=20) and combined general epidural anesthesia (group E G n=20). HR, MAP were monitored, blood gas and the concentrations of norepinephrine (NE) and blood glucose were measured before and after 30 minutes of pneumoperitoneum. Results (1) the HR, MAP in group G were significantly higher during pneumoperitoneum than that in group E and group E G. (2) the concentrations of glucose and NE were increased significantly in group G and group E during pneumoperitoneum, but not markedly changed in group E G. (3) The pressure of CO2 in group E was gradually increased during pneumoperitoneum than that in group G and group E G. Conclusions The combination of general epidural anesthesia can not only suppress the stress response and stabilize the hemodynamics, but also prevent the comulation of CO2 during LC.