高位硬膜外麻醉在微型腹腔镜甲状腺切除术中的研究  

Clinical study of high epidural anesthesia in thyroidectomy with micro laparoscope.

作　　者：张兴[1] 李锋[1] 陈凤坤[1] 黄华[1] 张福维[1] 范海鸥[1] 谭宗群[1] 

机构地区：[1]钦州市第一人民医院,广西钦州535000

出　　处：《现代保健（医学创新研究）》2007年第06Z期1-2,共2页

基　　金：2006年度钦州市科学研究与技术开发第二批计划项目（合同编号：20062709）

摘　　要：目的 探讨高位硬膜外麻醉在微型腹腔镜甲状腺切除术的麻醉效果及安全性。方法 选择ASAI～Ⅱ级，血压及心电图检查正常，术前血T3、T4正常，以5mmHg的CO2充气压力维持外科操作空间，择期行微型腹腔镜甲状腺切除术患者40例，随机分为高位硬外麻醉组（E组，n=20）和全麻插管组（G组，n=20），于麻醉前、CO2充气后10、30和60min分别观察呼气末二氧化碳分压（PET-CO2）数值，观察其变化；并观察麻醉后并发症发生情况。结果 充气后60min两组组内比较与麻醉前（充气前）的PETCO2显著增高（P〈0．05），但两组组间比较差异无显著性（P〉0．05）；术后嘶哑、咽痛、恶心呕吐、头晕、嗜睡等并发症发生，全麻插管组高于高位硬膜外麻醉组。结论 低CO2充气压力时，高位硬膜外麻醉下微型腹腔镜甲状腺切除术是安全可行的，术后并发症高住硬膜外麻醉组相对少于全麻插管组。Objective To discuss the anesthetic effect and safety of applying micro laparoscopic thyroidectomy under high epidural anesthesia. Methods Chose 40 patients of ASA I- H level, normal heart pressure and cardiogram, normal blood T3 , T4 prior to surgery, with a surgical space by introducing CO2 of 5 mmHg, to performed micro laparoscopic thyroidectomy. Randomly divided into a group by high epidural anesthesia （Group E, n = 20） and the other group by general anesthesia intubation （Group G, n = 20）. Before applying anesthesia and after introduced CO2, observed carbon dioxide partial pressure by end exhalation （ PETCO2 ） measurement at 10, 20, 30 and 60 minutes. Studied the changes, and observed any complication would occur after applying anesthesia. Results 60 minutes after introduced carbon dioxide, the PET- CO2 values were obviously higher than those （P 〈 0.05） before applying anesthesia （before carbon dioxide was introduced） in these two groups. However, there was no distinct difference between the two groups （ P 〉 0.05）. After surgery, complications such as husky voice, deglutition pain, emesia and lethargy occurred. The complication rate in Group G was higher than that in Group E. Conclusions Introduced CO2 at low pressure, thyroidectomy with micro laparoscope under high epidural anesthesia is safe and feasible. After surgery, complication occurring in Group E was relatively less than that in Group G.

关 键 词：高位硬膜外麻醉低压力CO2 微型腹腔镜 甲状腺切除术 

分 类 号：R614.42[医药卫生—麻醉学]