硬外复合静脉麻与气管全麻在小儿腹腔镜疝手术的比较

目的对比分析研究硬膜外复合丙泊酚静脉全麻与气管内全麻在小儿腹腔镜疝囊高位结扎手术中的优缺点。方法ASAⅠ-Ⅱ级择期行腹腔镜疝手术患儿40例，年龄在1～12岁，随机分为硬膜外复合丙泊酚静脉全麻组（E组）和气管内插管全麻组（G组）。观察气腹前，气腹后5min，10min，15min，放气后5min的MAP，HR，SpO2，PH，PaCO2，和术毕恢复时间，比较两者麻醉的费用。结果与气腹前比较，E组MAP，HR变化无显著性差异（P〉0．05），G组显著升高（P〈0．05）。两组患儿气腹15min后PaCO2均显著升高（P〈0．05）。停气腹后恢复至气腹前水平。E组麻醉苏醒时间明显快于G组，术后恶心呕吐发生率差异无显著性。E组麻醉费用比G组明显减少。结论硬外复合丙泊酚静脉全麻在小儿腹腔镜疝手术中，可有效抑制应激反应且经济安全，术毕苏醒时间快，苏醒质量好。

Comparison between epidural block anesthesia combined with propofol intravenous anesthesia and general anesthesia for laparoscopic hernial operation in children

Objective To compare the anesthesia combined with propofol intravnous advantages and disadvantages between epidural block anesthesia and general anesthesia in children for laparoscopic hernial operation. Methods 40 cases with ASA Ⅰ - Ⅱ , aged 1 to 12 years old were scheduled for laparoscopic hernial operation. The children were randomly divided into two groups, either receiving epidural block anesthesia combined with propofol intravenous anesthesia （Group E, 20 cases） or general anesthesia （Group G, 20 cases）. MAP, HR, SpO2,PH and PaCO2 before pneumoperitoneum or 5 min, 10 min, 15 min after CO2 pneumoperitoneum or 5 min after remoral of pneumoperitoneum were observed. Postoprative recovery, and anesthetic expenses were also evaluated. Results As compared with preoperative levels, the MAP and HR were no obvious difference in the group E （P〉0.05） after CO2 pneumoperitoneum, while remarkably increased in the group G （P〈0.05）. In both of groups, the PaCO2 levels were significantly increased after pneumoperitoneum 15 minutes in two groups （P〈0.05） and were gradually restored to normal levels after removal of pneumoperitoneum. The recovery time of anesthesia was significantly shorter in the group E than group G （P〈0.05）. The group E had significantly lower anesthetic expenses than group G （P〈0.05）. No significant difference were seen in incidence of nausea and vomiting between the two groups （P〉0.05）. Conclusions As compared with general anesthesia, epidural block anesthesia combined with propofol intravenous anesthesia has a cheaper and safer result. It would effectively inhibit stress reaction and improve postoperative recovery for laparoscopic hernial operation in children.