高位硬膜外复合全麻在腹腔镜肝脏切除中的应用

  目的  探讨高位硬膜外复合全麻在腹腔镜肝脏切除术中的应用。  方法  随机选取曲靖市第二人民医院2020年3月至2022年9月间，腹腔镜肝脏切除术患者86例为对象，采用数字表法均分为2组各43例。对照组围术期行全身麻醉；观察组采用高位硬膜外复合全麻。记录2组围术期血流动力学水平、T淋巴细胞亚群、术中出血量及麻醉相关并发症情况。  结果  2组围术期血流动力学呈先上升后下降趋势；2组T1、T2时间点SBP、DBP及HR水平高于T0时间点，差异有统计学意义（P < 0.05）；观察组T1、T2时间点SBP、DBP及HR水平低于对照组，差异有统计学意义（P < 0.05）；2组术后48 h T淋巴细胞水平出现不同程度下降；观察组CD3+、CD4+、CD4+/CD8+水平高于对照组，差异有统计学意义（P < 0.05）；2组呼吸暂停、苏醒延迟、低氧血症、呼吸抑制及尿潴留发生率比较，差异无统计学意义（P > 0.05）。  结论  高位硬膜外复合全麻用于腹腔镜肝脏切除术中，能稳定血流动力学水平，还能降低患者中心静脉压，且未增加术中出血，对T淋巴细胞亚群水平影响较小，麻醉安全性较高，值得推广应用。

Application of High Epidural Combined General Anesthesia in Laparoscopic Liver Resection

  Objective  To investigate the application of high epidural combined general anesthesia in laparoscopic liver resection.   Methods  A total of 86 patients with laparoscopic hepatectomy in the Second People’s Hospital of Qujing City from March 2020 to September 2022 were randomly selected and divided into 2 groups with 43 cases in each group by the number table method. The control group received general anesthesia during perioperative period, while the observation group received high epidural combined general anesthesia. The perioperative hemodynamic level, Perioperative hemodynamic level, T lymphocyte subsets, intraoperative blood loss and anesthesia related complications were recorded in the two groups.   Results  The perioperative hemodynamics of the two groups increased first and then decreased. The levels of SBP, DBP and HR at T1 and T2 in the two groups were higher than those at T0, and the differences were statistically significant （P < 0.05 ）. The levels of SBP, DBP and HR at T1 and T2 in the observation group were lower than those in the control group, and the differences were statistically significant （ P < 0.05 ）. The level of T lymphocytes in the two groups decreased in different degrees at 48 h after operation. The levels of CD3+, CD4+ and CD4+/CD8+ in the observation group were significantly higher than those in the control group （P < 0.05 ）. There was no significant difference being found in the comparison of the incidences of apnea, delayed recovery, hypoxemia, respiratory depression and urinary retention between the two groups （P > 0.05 ）.  Conclusion  The application of high epidural combined general anesthesia in laparoscopic liver resection can stabilize the hemodynamic level, reduce the central venous pressure of patients, and does not increase intraoperative bleeding, has little effect on the level of T lymphocyte subsets, and has high anesthesia safety, which is worthy of promotion and application.