妇科腹腔镜手术的麻醉选择  

The Method of Anaesthesia Choice of Laparoscopic Operation in Department of Gynecology

作　　者：周惠明[1] 周少宇 于芳[2] 谭霞玲 

机构地区：[1]广东省肇庆市第二人民医院麻醉科,526060 [2]广东省肇庆市第二人民医院妇产科,526060

出　　处：《中国医药指南》2009年第7期15-16,21,共3页Guide of China Medicine

摘　　要：目的通过对比观察两种麻醉方法对妇科腹腔镜手术患者应激反应、血流动力学、呼吸的影响及术后并发症的发生。方法选择妇科腹腔镜手术60例,ASAⅠ级,随机双盲法分为两组,Ⅰ组采用腰-硬联合麻醉辅助丙泊酚平衡麻醉(CSEA组),Ⅱ组采用气管插管静吸全麻(GA组)。观察记录两组患者麻醉前T1、CO2气腹前5min(T2)、CO2气腹达15mmHg后10min(T3)、40min(T4)及术毕放气后10min(T5)SBP、HR、SpO2、ECG、PETCO2变化,术后随访记录两组患者恶心、呕吐、躁动的发生情况及对麻醉方式的满意度。结果CESA组各时点SBP、HR变化不大,比较无区别(P>0.05);GA组T3、T4时点SBP、HR显著高于T1时点(P<0.05),亦显著高于CSEA组同时点(P<0.05)。CSEA组患者SpO2均>96%,与GA组比较无区别(P>0.05)。术后随访CSEA组恶心呕吐2例(6.7%),无躁动,满意度25例(83.3%)。GA组恶心、呕吐10例(33%),躁动12例(40%),满意度仅9例(30%)。结论腰-硬联合麻醉辅助丙泊酚平衡麻醉,麻醉效果确切,能有效抑制应激反应,同样可作为妇科腹腔镜手术的麻醉选择。Objective Observed by comparing the two methods of anesthesia in patients with gynecologic laparoscopic surgery on stress reaction, hemodynamics, respiration and postoperative complications. Methods Select 60 patients of gynecologic laparoscopic surgery.ASA I level, randomized, double-blind method is divided into two groups, I group adopted Combined spinal and epidural anesthesia assisted balanced propofol anesthesia （CSEA group）; Ⅱ group adopted intubation-inhalation general anesthesia （GA group）; Observation and record： the two groups before anesthesia in patients with T1 and CO2, pneumoperitoneum before 5rain （T2）, CO2 pneumoperitoneum tatsu 15mmHg after 10min （T3） and 40min （T4） and after surgery were deflated 10min （Ts） SBP, HR, SpO2, ECG and PETCO2 changes;Record the two groups of patients with postoperative follow-up Nausea, vomiting, restlessness and the incidence of anesthesia satisfaction. Results CSEA each point in time SBP, HR changed little compared Without distinction （P〉0.05）; GA group T3, T4 point SBP, HR was significantly higher than T1 time point （P〈0.05）, also significantly higher than at the same time point CSEA group （P〈 0.05）. CSEA patients were SpO2 〉 96%, with the GA group no difference between （P〉 0.05）.CSEA group were followed up two cases of nausea and vomiting （6.7%）, 25 cases of without agitation and satisfaction（83.3%）; GA group of 10 cases of nausea and vomiting （33%）, 12 cases of restlessness （40%）, only nine cases of satisfaction （30%）. Conclusion Combined spinal and epidural anesthesia assisted balanced propofol anesthesia, anesthetic effect is precise and can effectively inhibit the stress response, same as gynecological laparoscopic surgery anesthesia choice.

关 键 词：腹腔镜手术 应激反应 腰-硬联合麻醉 气管内全麻 平衡麻醉 

分 类 号：R713[医药卫生—妇产科学]