单纯全麻与硬膜外联合全麻用于腹腔镜手术的比较

目的 比较单纯全麻与硬膜外联合全麻用于腹腔镜手术的效果。方法 将拟行腹腔镜手术患者40例随机分为全麻组（G组，20例）和硬膜外联合全麻组（GE组，20例）。术中连续监测血压（BP），心率（HR），血氧饱和度（SPO2），心电图（ECG）和气道压；测定患者麻醉前、气腹后20 min及术毕拔除气管导管后5 min 3个时点的血糖浓度及血气；观察并记录两组病人术中麻药用量，术后苏醒时间，术后躁动发生率和术后肺部感染率。结果 与GE组比，G组在气腹后20 min 和拔管后5 min时HR及MAP均显著增加（P〈0.05）。气腹后20 min时两组气道压和血糖水平均升高，但Ｇ组升高较明显（P〈0.05）。血气分析在气腹后20 min时两组HCO3^-均明显高于麻醉前（P〈0.05），但组间比较差异无统计学意义。与G组比，GE组病人术中麻药用量少，术后苏醒时间短，躁动发生率低，术后肺部感染率低（P〈0.05）。结论 硬膜外联合全麻用于腹腔镜手术时对循环和内分泌影响小，肺部感染率低,是一种可行的麻醉方法。

Simply general anesthesia combined with epidural-general anesthesia in laparoscopic surgery

Objective To compare the effect of simply general anesthesia and general anesthesia combined with epidural - general anesthesia in laparoscopie surgery. Methods Forty patients scheduled for select laparoscopic surgery who were randomly divided into general anesthesia group（ Group G, n =20） and general anesthesia com- bined with epidural block group（ Group GE, n =20）. BP, HR, SPO2, ECG and airway pressure were continuously monitored. The blood gas analysis and concentration of blood glucose were determined at the following three time points; before anesthesia and at 20min after pneumoperitoneum and at 5min after detuhation. Intraoperative anesthetic dosage, postoperative awakening time, postoperative pulmonary infection and postoperative resdessness were observed and recorded. Results Compared with Group GE, MAP and HR in Group G were increased significantly at 20min after pneumoperitoneum and at 5min after deubation （P 〈0.05 ）. Airway pressure and the level of blood glucose were both increased in two groups at 20min after pneumoperitoneum, but there was a obvious increase in Group G （P 〈 0.05）. Compared with pre -anesthesia, HCO3^- were both increased in two groups at 20min after pneumoperitoneum by blood gas analysis（ P 〈 0.05 ）, but there was no diference betwen Group GE and Group G. Compared with Group G, postoperative awakening time was shorter, Intraoperative anesthetic dosage were less, and the incidence of postoperative resdessness and postoperative pulmonary infection was lower in Group GE .（ P 〈 0. 05 ）. Conclusion General anesthesia combined epidural - general anesthesia has a less effect on the endocrine and circulatory function and a lower incidence of postoperative pulmonary infection, so it is a good choice of anesthesia for laparoscopic surgery.