不同麻醉方法对后腹腔镜输尿管切开取石术血液动力学的影响

目的：探讨全身麻醉和全麻复舍硬膜外麻醉对后腹腔镜输尿管切开取石术血液动力学的影响。方法：40例行后腹腔镜输尿管切开取石术患者，随机分成A、B两组，各20例，分别接受全身麻醉和全麻复合硬膜外麻醉。采用桡动脉及颈内静脉穿刺监测HR、MAP、CVP。结果：A组在切皮、气腹后15min、气腹后30min、拔管后的HR、MAP、CVP均较切皮前明显增加（P〈0．05）；B组除CVP在气腹时略有增加外（P〈0．05），HR、MAP均无明显变化（P〉0．05）；两组间比较有显著差异（P〈0．05）。结论：全麻复合硬膜外麻醉能显著减轻后腹腔镜输尿管切开取石术中的应激反应，维持血液动力学的稳定，是后腹腔镜输尿管切开取石术较为理想的麻醉方式。

The effects of different anaesthesia on hemodynamics buring retroperitoneal laparoscopic ureterolithotomy.

Objective： To observe hemodynamics changes during retroperitoneal laparoscopic ureterolithotomy under general anesthesia or combination of general and epidural anesthesia. Methods： 40 patients undergoing elective retroperitoneal laparoscopic ureterolithotomy were randomly divided into general anesthesia group（A group, n= 20）and general anesthesia combined with epidural anesthesia group（B group, n= 20）. The hemodynamics changes were measured with radial artery puncture and internal jugular vein puncture. Results： HR, MAP,CVP were increased significantly after cutting skin, peritoneal insufflation, decannulation in A group （P〈0. 05） ;in B group, all parameters had no significant changes except CVP was slightly increased in peritoneal insufflation. HR, MAP,CVP in A group were increased significantly against B group（P〈0.05）. Conclusions：When compared with general anesthesia, the combination of general and epidural anesthesia could maintain hemodynamic during retroperitoned laparoscopic ureterolithotomy surgery.