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作 者:温汉新[1] 曹殿青[1] 何海燕[1] 揭育丽 姚业兴[1] 张凤兰[3]
机构地区:[1]广东医学院附属医院麻醉科,湛江市524001 [2]广东医学院附属医院同位素科,湛江市524001 [3]广东医学院附属医院妇科,湛江市524001
出 处:《临床麻醉学杂志》2006年第6期432-434,共3页Journal of Clinical Anesthesiology
摘 要:目的观察两种麻醉方法对腹腔镜子宫切除术患者应激反应的影响。方法选择拟行腹腔镜子宫切除术患者60例,随机分为两组,每组30例。Ⅰ组采用罗比卡因复合小剂量芬太尼行硬膜外麻醉,并辅以丙泊酚静脉泵注给予镇静(观察组);Ⅱ组采用以丙泊酚为主静脉复合全麻(对照组)。于麻醉前(T0)、CO2气腹前5min(T1)、CO2气腹后10min(T2)、40min(T3)、术毕10min(T4)抽肘静脉血检测血浆皮质醇(Cor)、去甲肾上腺素(NE)、肾上腺素(E)、血糖(Glu)和促肾上腺皮质激素(ACTH)浓度,并记录各时点MAP、HR、SpO2。结果与T0时比较,Ⅰ组各时点Cor、NE、E、Glu、ACTH及MAP、HR、SpO2差异无显著意义,Ⅱ组T2、T3时Cor、NE、E、Glu、ACTH及MAP、HR显著高于T0时(P<0·05);组间比较,Ⅱ组T2、T3时Cor、NE、E、Glu、ACTH及MAP、HR亦显著高于Ⅰ组同时点(P<0·05)。结论罗比卡因复合芬太尼硬膜外阻滞辅以丙泊酚镇静对腹腔镜子宫切除术的应激反应有抑制作用。Objective To explore the clinical effects of two different anesthesia methods on stress response in patients undergoing laparoscopic hysterectomy. Methods Sixty patients undergoing laparoscopic hysterectomy were selected and divided into two groups wit 30 cases cach. Epidural anesthesia (EA) was used with ropivacaine and fentanyl combined with intravenous propofol in group Ⅰ . Total intravenous anesthesia (TIVA) was maintained with propofol, fentanyl and atracurium in group Ⅱ. Peripheral venous blood was extracted before anesthesia (T0), at 5 min (T1) before pneumoperitoneum with CO2 (PPC), 10 min(T2) and 40 min (T3) after PPC, 10 min (T4) after operation for the measurements of plasma cortisone(Cor), nor epinephrine (NE), epinephrine (E), glucose (Glu) and ACTH. Results There was no significant difference in plasma Cor, E, NE, ACTH, Glu and MAP, HR, SpO2 among all time points in group Ⅰ. All those measurements increased significantly in group Ⅱ at T2 and T3, compared with those at To (P〈0.05) and with those in group I at T2 and T3 (P〈0.05). Conclusions EA with ropivacaine and fentanyl combined with intravenous propofol infusion has little effect on stress response in patients undergoing laparoscopic hysterectomy.
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