全麻复合硬膜外麻醉对胆囊切除术患者心血管应激的影响研究

目的探讨全身麻醉复合硬膜外麻醉对胆囊切除患者术中心血管应激反应的影响，为胆囊切除术中麻醉安全提供参考。方法82名胆囊切除术患者随机分为研究组及对照组，两组患者均采用全身麻醉，研究组复合硬膜外麻醉，比较两组患者麻醉过程及手术过程心血管反应的差异及血清肾上腺素及去甲肾上腺素水平变化。结果两组患者插管前心率（heartrate，HR）、平均动脉压（mean arterial pressure，MAP）无差异，插管后及拔管后研究组患者HR、MAP低于对照组，牵拉胆囊时研究组患者HR、MAP高于对照组。两组患者插管前及插管后血清肾上腺素及去甲肾上腺素水平无显著差异，牵拉胆囊后及拔管后研究组血清肾上腺素及去甲肾上腺素水平低于对照组。结论全麻复合硬膜外麻醉能够减轻胆囊切除患者心血管应激反应，增加麻醉安全，可能与其对植物神经反射通路的阻断作用有关。

Effect of General Anesthesia Combined Epidural Block to Cardiovascular Stress on Patients with Cholecystectomy

Objective To evaluate the effect of general anesthesia combined epidural block to cardiovasular stress on patients with cholecystectomy, and provide reference for safety in cholecystectomy. Methods All 82 cases of patients who taken cholecystectomy were randomly divided into research groups and control groups, all patients taken general anesthesia, patients in research groups combined epidural block, cardiovasular stress and level of adrenaline （ AD ） and norepinephrine （ NE ） in serum were contrasted between research groups and control groups during operations and anesthesia. Results Mean arterial pressure（ MAP ）and heart rate（ HR ） was identical between search groups and control groups before trachea cannula, HR and MAP were lower in research groups than in control groups after trachea cannula and pulling out trachea cannula, HR and MAP were higher in research groups than in control groups when gallbladder were draged. Level of AD and NE was identical between search group and control group before trachea cannula; Level of AD and NE was lower in research group than in control group after trachea cannula and pulling out trachea cannula; Level of AD and NE was higher in research group than in control group when gallbladder were draged. Conclusion General anesthesia combined epidural block could decrease cardiovasular stress on cholecystectomy and improve anaesthetic safety, that maybe was result of blocking reflex path of autonomic nerve.