对221例妇科腹腔镜手术的麻醉处理的临床分析

目的探讨静脉全身麻醉与全麻复合硬膜外麻醉2种方法用于妇科腹腔镜手术的特点。方法回顾性分析我院2008年10月至2010年11月收治的腹腔镜妇科手术病例221例,A组：116例,丙泊酚静脉复合麻醉。B组：105例,丙泊酚静脉麻醉加硬膜外阻滞麻醉。观察记录麻醉前后不同时间血压、心率、呼气末二氧化碳分压、脉搏氧饱和度、术毕清醒时间、拔管时间及术中知晓情况。结果静脉全身麻醉组麻醉和气腹对循环、呼吸影响最大,静脉全身麻醉组麻醉和气腹后平均动脉压、心率、呼气末二氧化碳分压明显升高,脉搏氧饱和度不降,术毕清醒时间明显长于全麻复合硬膜外麻醉组,术中知晓发生率介于（P〈0.05）,全麻复合硬膜外麻醉组平均动脉压下降,心率变化不明显（P〉0.05）、呼气末二氧化碳分压、脉搏氧饱和度增加（P〈0.05）;术后清醒和拔管时间快于静脉全身麻醉组,术中疼痛知晓发生率最低（P〈0.01）。2组放气腹后呼气末二氧化碳分压较麻醉前明显增加（P〈0.01）。结论全麻复合硬膜外阻滞麻醉,麻醉平稳、效果可靠,血流动力学相对稳定,术后苏醒快,费用低,适合妇科腹腔镜手术麻醉。

Gynecology Laparoscopic Surgery Anesthesia Processing of Clinical Analysis In 221 Cases

Objective To investigate the intravenous anesthesia composite with general anesthesia epidural anesthesia are two method used in gynecology laparoscopic surgery characteristics.Methods Retrospective October 2008 to 2010 November 57.0% laparoscopic gynecological surgery 221 cases,group A case：116 cases,propylene tabor phenolic compound vein anesthesia.Group B：105 cases,propylene tabor phenol with intravenous anesthesia epidural block anesthesia.Observation records anesthesia different time before and after the blood pressure and heart rate,expiratory pressure and pulse carbon dioxide points at the end of oxygen saturation,perioperative Picasso sober time,decannulation time and intraoperative awareness.Results Intravenous anesthesia general anesthesia group of circulation,breathing and gasless biggest influence,intravenous general anesthesia group anesthesia and gasless after mean arterial pressure,and heart rate,expiratory pressure at the end of the carbon dioxide points increased significantly,pulse oxygen saturation not drop,perioperative anesthesia significantly longer than Picasso sober composite peridural anesthesia group,intraoperative awareness rate between（P0.05）,compound general anesthesia epidural anesthesia group mean arterial pressure drop,heart rate does not change significantly（P0.05）,expiratory pressure and pulse carbon dioxide points at the end of oxygen saturation increased（P0.05）.Postoperative awake and extubated time faster than venous general anesthesia group,intraoperative awareness rate lowest pain（P0.01）.Two groups put at the end of the carbon dioxide points after gasless expiratory pressure relatively anesthesia before increased significantly（P0.01）.Conclusion Thirty-two composite epidural anesthesia block anesthesia,smooth,reliable,effect of hemodynamic relative stability,postoperative revive fast,low cost,suitable for gynecology laparoscopic surgery anesthesia.