硬膜外阻滞加静吸复合麻醉对腹腔镜结肠癌根治术应激反应的影响

目的评价硬膜外阻滞加静吸复合麻醉对腹腔镜结肠癌根治术应激反应的影响。方法28例择期行腹腔镜结肠癌根治术的患者,随机分为硬膜外阻滞加静吸复合麻醉组(GE组)和单纯静吸复合全麻组(G组),每组各14例。分别监测人工气腹前和气腹后1、2、3h的MAP、ECG、HR、SpO2及PETCO2的情况,并同时进行血气分析和血肾上腺素(E)及去甲肾上腺素(NE)浓度的测定。结果于气腹后1、2、3h时,E和NE值两组均较气腹前升高,但G组升高尤为显著(P<0.05),而组间比较,GE组明显低于G组(P<0.05);G组MAP、HR均较气腹前升高(P<0.05),GE组HR较气腹前降低(P<0.05),而组间比较,MAP、HR差异有统计学意义(P<0.05);PaCO2值与气腹前比较两组差异均有统计学意义(P<0.05);而气腹后3hpH值低于正常值,与气腹前比较差异有统计学意义(P<0.05)。结论硬膜外阻滞加静吸复合麻醉可有效地抑制腹腔镜结肠癌根治术中因较长时间气腹所引起的应激反应。

Effects of combined epidural block with inhalation- intravenous general anesthesia on stress response of patients for laparoscopic radical colonectomy

Objective To investigate the effects of combined epidural block with inhalation - intravenous general anesthesia (GE) on stress response in thepatients for laparoscopic radical colonectomy. Methods Twenty-eight ASA I-II patients scheduled for laparoscopic radical colonectomy were randomly divided into group GE and inhalation-intravenous general anesthesia group(group G) with 14 cases each. In group GE, epidural blocks were operated before induction, MAP,ECG ,HR,SpO2 and PETCO2 were observed and recorded at such point-time: pre-pneumoperitoneum and 1,2,3 h after pneumoperitoneum. Arterial blood-gas analysis ,noradrenaline(NE) and adrenaline(E) were also measured at the same time; Group G was the same as group GE except for no epidural block and extra fentanyl. Results The level of stress response hormones(NE and E) of post- pneumoperitoneum 1,2,3 h were increased VS those of pre-pneumoperitoneum in both groups, and group G was significant (P < 0.05), the level of stress response hormones(NE and E) of post- pneumoperitoneum 1,2,3h in group GE were significantly lower than those in group G(P < 0.05); MAP,HR of post-pneumoperitoneum 1,2,3 h were increased VS those of pre- pneumoperitoneum in group G (P < 0.05), HR of post-pneumoperitoneum 1,2,3h were lower than those of pre- pneumoperitoneum in group GE (P < 0.05), MAP and HR of post-pneumoperitoneum 1,2,3h in group GE were significantly different from those in group G (P < 0.05); PaCO2 of post-pneumoperitoneum 1,2,3h were significantly different from those of pre- pneumoperitoneum in both groups (P < 0.05); pH of post-pneumoperitoneum 3h was lower than normal. Conclusion The combined epidural block with inhalation-intravenous general anesthesia can effectively resist the stress response for long pneumoperitoneum during laparoscopic radical colonectomy.