硬膜外麻醉与全身麻醉下妇科腹腔镜手术病人的血液动力学与血糖变化

目的观察比较硬膜外麻醉和全身麻醉用于妇科腹腔镜手术时患者围麻醉期血流动力学及血糖的变化。方法60例妇科腹腔镜手术病人均分为两组:硬膜外麻醉组(EA组)和全身麻醉组(GA组)。分别于麻醉前、腹压达12mmHg后1min和30min、术毕四个时点监测HR、SBP、DBP、SpO2的变化,并于上述时点测血糖(BS)变化。结果两组手术前后HR无明显变化,在气腹1minEA组HR高于GA组(P<0.01);EA组SBP在气腹30min和术毕均低于麻醉前水平(P<0.05);GA组在气腹后DBP和SBP明显高于麻醉前(P<0.01和P<0.05),DBP直到术毕仍高于麻醉前水平(P<0.05);组间血压比较:气腹后和术毕EA组SBP和DBP明显低于GA组(P<0.05或P<0.01),但维持在正常范围;EA组气腹前后BS的变化无统计学意义(P>0.05),而GA组术毕时BS水平明显高于麻醉前(P<0.05)。结论合适阻滞平面的硬膜外麻醉能较好地消除气腹引起的血压升高和应激反应。

Change of concentration of blood glucose and hemodynamics undergoing gynecologic laparoscopy under epidural or general anesthesia

[Objective] To study the changes of concentration of blood glucose(BS)and hemodynamics undergoing gynecologic laparoscopy under epidural or general anesthesia. [Methods] 60 gynecologic patients were randomly divided into epidural anesthesia group (group EA, n =30) and general anesthesia group (group GA, n =30) respectively. The changes of HR, SBP, DBP, SpO2 were monitored before anesthesia, at 1 min, 30 min after pneumoperitoneum(pp) was to 12mmHg, and at end of operation. The blood samples were taken for the measurements of blood concentration of glucose at the same time points as above. [Results] HR was not significantly changed before and after operation, but HR was higher in group EA than that in group GA at 1 min after pp (P <0.01); SBP was significantly lower at 30 min after pp and after operation finished compared with that before anesthesia in group EA (P <0.05); DBP and SBP were increased significantly after pp when compared with that before anesthesia(P <0.01 and P <0.05) in group GA,DBP was higher at all the time compared with that before anesthesia (P <0.05) in group GA; Blood pressure in the two groups was significantly difference after pp and post operation (P <0.05, P <0.01). BS had no significantly change during pp in group EA, but in group GA, BS was significantly increased compared with that before anesthesia (P <0.05). [Conclusion] Epidural block can effectively eliminate the increase of BP induced by pp and stress reaction.