静吸复合麻醉联合硬膜外麻醉对腹腔镜胆囊手术患者血流动力学及术后恢复的影响

目的：探讨静吸复合麻醉联合硬膜外麻醉对腹腔镜胆囊手术患者术中血流动力学及术后恢复效果的影响。方法选择需行胆囊摘除术患者124例，随机分为对照组和试验组，每组62例。对照组患者只接受静吸复合麻醉，试验组患者接受静吸复合麻醉联合硬膜外麻醉。分别评估2组患者术中5个时间点血流动力学指标的变化，包括心率（ heart rate，HR）、收缩压（ systolic blood pressure，SBP）和舒张压（ diastolic blood pressure，DBP）；记录2组患者术后苏醒时间、拔管时间以及出室时间以比较其术后恢复情况；记录2组患者术后出现恶心呕吐、寒战和气管痉挛的人数。结果2组患者HR在入室时（T0）和气腹后60 min（T4）差异无统计学意义（ P ＞0．05），但在诱导时（T1）、气腹时（T2）和气腹后30 min（T3）试验组患者HR显著低于对照组患者（ P ＜0．05）；2组患者SBP在入室时（T0）和气腹后60 min（T4）差异无统计学意义（ P ＞0．05），但在诱导时（T1）试验组患者SBP显著高于对照组（ P ＜0．05），气腹时（T2）和气腹后30 min（T3）试验组患者SBP显著低于对照组（ P ＜0．05）；2组患者DBP入室时（T0）和气腹后60 min （T4）差异无统计学意义（ P ＞0．05），但在诱导时（T1）、气腹时（T2）和气腹后30 min（T3）试验组患者DBP显著低于对照组（ P ＜0．05）。2组患者术后苏醒时间、拔管时间和出室时间差异无统计学意义（ P ＞0．05）。试验组患者出现恶心呕吐、寒战和气管痉挛的人数显著少于对照组（ P ＜0．05）。结论静吸复合麻醉联合硬膜外麻醉可以有效缓解腹腔镜胆囊手术中患者循环系统的波动，有效避免术后并发症的出现，且对术后恢复时间没有影响，值得临床推广。

Effects of intravenous anesthesia combining with epidural anesthesia on hemodynamics and postoperative recovery in patients receiving laparoscopic cholecystectomy

Objective To investigate the effects of intravenous anesthesia combined with epidural anesthesia on hemodynamics and postoperative recovery in patients receiving laparoscopic cholecystectomy.Methods One hundred and twenty-four patients who underwent laparoscopic cholecystectomy in our hospital from January 2014 to January 2015 were randomly divided into control group and trial group, with 62 patients in each group.The patients in control group received intravenous anesthesia,however,the patients in trial group received intravenous anesthesia combined with epidural anesthesia. The hemodynamic parameters in 5 time points were evaluated in both groups,and these parameters included heart rate ( HR) , systolic blood pressure (SBP) and diastolic blood pressure (DBP).The postoperative analepsia time, extubation time and leaving time from operating room were observed and compared between two groups. Moreover the incidence rates of postoperative nausea and vomiting, chills and bronchospasm were observed in both groups.Results When the patients entered operating room (T0) and on 60min after pneumoperitoneum (T4), there were no significant differences in HR levels between two groups ( P >0.05 ), however, during induction ( T1 ), pneumoperitoneum ( T2 ) and on 30min after pneumoperitoneum (T3), the HR levels in trial group were significantly lower than those in control group ( P <0.05).There were no significant differences in SBP levels in T0 and T4 between two groups ( P >0.05),however,the SBP levels in T1 in trial group were significantly higher than those in control group ( P <0.05),but the SBP levels in T2,T3 in trial group were significantly lower than those in control group ( P <0.05).There were no significant differences in DBP levels in T0 and T4 between two groups ( P >0.05), however,the DBP levels in T1,T2,T3 in trial group were significantly lower than those in control group ( P <0.05).There were no significant differences in postoperative analepsia time, extubation time and leaving time from operating room between two groups ( P >0.05),however, the numbers of patients who had nausea and vomiting, chills and bronchospasm in trial group were significantly less than those in control group ( P <0.05 ) .Conclusion The research results suggest that intravenous anesthesia combined with epidural anesthesia can effectively relieve the fluctuation of circulatory system in patients undergoing laparoscopic cholecystectomy, and can effectively avoid the occurrence of postoperative complications, moreover, which has no effects on postoperative recovery time,thus,which is worth using widely in clinical practice.