平衡麻醉与全凭静脉麻醉在腹腔镜子宫切除术中的比较

目的 观察平衡麻醉与全凭静脉麻醉对腹腔镜下行子宫切除术患者血流动力学及呼吸功能的影响.方法 40例择期行腹腔镜子宫切除术的患者分别接受平衡麻醉(n=20)与全凭静脉麻醉(n=20),记录围术期血流动力学参数、呼吸参数、动脉血气的变化并计算呼吸系统顺应性.结果 平衡麻醉组气腹后10min的平均动脉压(MAP)显著高于诱导前(P＜0.05),放气前即刻及术毕时平衡麻醉组PaO2显著低于诱导前、平衡麻醉组与全凭静脉麻醉组PaCO2显著高于诱导前(P＜0.05);平衡麻醉组放气前即刻的PETCO2、放气前即刻及术毕的HR及诱导后各时间点的MAP均显著高于全凭静脉麻醉组,而放气前即刻及术毕的PaO2明显低于全凭静脉麻醉组(P＜0.05).平衡麻醉组气腹期间呼吸系统顺应性明显低于全凭静脉麻醉组(P＜0.05).结论 全凭静脉麻醉对腹腔镜子宫切除术患者血流动力学及呼吸功能的影响小于平衡麻醉.

Comparison of balanced anesthesia and total intravenous anesthesia during laparoscopic hysterectomy

Objective To investigate the influence of balanced anesthesia(BA)versus total intravenous anesthesia(TIVA)on the hemodynamics and respiratory function of patients undergoing laparoscopic hysterectomy.Methods Two groups of patients undergoing elected laparoscopic hysterectomy received balanced anesthesia(BA group,20 cases)or total intravenous anesthesia(TIVA group,20 cases)respectively.Data of hemodynamics and respiratory system were recorded and the compliance of respiratory system was calculated.Results The MAP at 10 minutes after pneumoperitoneum(PP)was elevated significantly than that before-induction in BA group(P<0.05).At the time just before deflation and at the end of operation,PaO2 in BA group was lowered significantly than that before-induction,and PaCO2 in BA group and in TIVA group was raised distinctly compared with that before-induction(P<0.05).The PETCO2 at the time before deflation,the HR at the time just before deflation and at the end of operation,and the MAP at all the time points after induction in BA group were all significantly higher than those in TIVA group(P<0.05).However,the PaO2 at the time just before deflation and at end of operation in BA group was distinctly lowen than that in TIVA group(P<0.05).The calculated compliance of respiratory system during pneumoperitoneum in BA group was significantly decreased than that in TIVA group(P<0.05).Conclusion Total intravenous anesthesia evokes less influence on the hemodynamics and respiratory function than balanced anesthesia during laparoscopic hysterectomy.