连续硬膜外麻醉结合喉罩通气在直肠癌腹腔镜手术中的应用

为探讨连续硬膜外麻醉结合喉罩通气用于直肠癌腹腔镜手术的安全性、有效性，本研究将60例直肠癌择期行腹腔镜手术患者随机分为两组，一组选择连续硬膜外麻醉结合喉罩通气（A组），一组选择气管插管静吸复合麻醉（B组），比较两组在诱导前、诱导后、插管（置喉罩）即刻、拔管（拔喉罩）即刻心率（HR）、平均动脉压（MAP）、心电图（ECG）、呼吸频率（RR）、潮气量（VT）、气道峰压（Pmax）、气道平均压（Pmean）、血氧饱和度（SPO。）、呼气末CO2分压（PET，CO2）、动脉血CO2分压（PaCO2）等各项指标的变化，并记录全麻用药量及患者苏醒时间。结果显示，A组患者全麻药用量明显少于B组（P〈0．05），术毕自主呼吸恢复时间、拔管时间和离开手术室时间明显短于B组（P〈0．05）。插管即刻和拔管即刻，B组患者HR明显增快，MAP明显增高，明显快于和高于A组（P〈0．05）。结果表明，连续硬膜外麻醉结合喉罩通气用于直肠癌腹腔镜手术安全有效，而且可减少全麻药的用量，达到苏醒快、术后恢复快的目的，但使用喉罩时仍存在返流误吸的危险，应加以注意和预防。

Application of Continuous Epidural Anesthesia Combined with Laryngeal Mask Ventilation During Laparoscopic Operation for Rectal Carcinoma

In order to explore the safety and effectivity of continuous epidural anesthesia combined with la- ryngeal mask ventilation used in laparoscopic operation for rectal carcinoma, this study divided random 60 patients with rectal carcinoma to be receive scheduled operation into two group. A and B group. A group was subjected to above-mentioned method,B group to compound venous anesthesia with tracheal insertion catheter inhalation; the HR, MAP, ECG, RR, VT, Pmax, Pmean, SPO2, PET CO2, PaCO2, etc, at pre-induc- tion,post-induction, at once for cannula （placing larnygeal mask）, and at once for withdrawing catheter （withdrawing larnygeal mask） were recorded, then compared and analysed their results And, the dosage for general anesthesia and emergence time of patient were recokded. As results,in A group the dosage for general anesthesia,automatic respiration recovery time, withdrawing catheter time at the end of operation and the time out from operation room,was less,and shorter than in B group（ P 〈0.05,all）in B group at right cannula and withdrawing catheter HR of patients and MAP of patients was significantly faster and higher than in A group（ P 〈0.05）. Results show that continuous epidural anesthesia combined with laryn- geal mask ventilation used during laparoscopic operation for rectal carcinoma is safe and effective,and can reduce the dosage for general anesthesia, achieve the goal of fast emergence and postoperative recovery; But,it is noticed and prevented the risk from reflux inducing wrong inhalation during using laryngeal mask.