不同麻醉方式用于单孔腹腔镜下乙状结肠原位新膀胱术临床效应的比较  

Comparison of different anesthesia methods during single-port laparoscopic sigmoid colon orthotopic neobladder construction

作　　者：张庆国[1] 刘中杰[1] 刘民强[2] 徐世元[1] 

机构地区：[1]南方医科大学珠江医院麻醉科,广州510282 [2]广东省深圳市第三人民医院麻醉科,518112

出　　处：《广东医学》2013年第5期693-695,共3页Guangdong Medical Journal

摘　　要：目的比较单纯全麻和全麻联合硬膜外阻滞用于单孔腹腔镜下乙状结肠原位新膀胱术的临床效果。方法择期行单孔腹腔镜下全膀胱切除并乙状结肠原位新膀胱术患者40例(ASAⅡ级或Ⅲ级),随机分为单纯全麻组(G组,n=20)和全麻联合硬膜外阻滞组(GE组,n=20)。记录麻醉前(T0),气腹前5 min(T1),气腹后10 min(T2)、30 min(T3)、90 min(T4)、180 min(T5),解除气腹后30 min(T6)及术毕(T7)各时点心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、气道压力(Paw)、呼气末二氧化碳分压(PETCO2)、二氧化碳分压(PaCO2)、pH值、血糖(Glu)、Narcotrend麻醉深度指数以及手术时间、气腹时间、出血量、丙泊酚与瑞芬太尼用量、拔管时间、苏醒时间及术后躁动发生率。结果两组气腹建立后HR、MAP、CVP、Paw、PETCO2、PaCO2及Glu值均升高,pH值下降(P<0.05)。T2、T3、T6、T7时G组HR、MAP较GE组升高更明显(P<0.05);T2～T7时G组Glu较GE组升高更显著(P<0.01);G组与GE组术中瑞芬太尼用量、术后拔管时间、躁动发生率分别为(3.8±0.7)mg与(2.5±0.5)mg,(16.3±7.2)min与(5.9±2.6)min,25%与10%,差异有统计学意义(P<0.05,P<0.01)。结论全麻联合硬膜外阻滞较单纯全麻可减轻单孔腹腔镜下乙状结肠原位新膀胱术的伤害性刺激反应,气腹初期及解除气腹后血流动力学波动较小,阿片类药物用量少,术后苏醒质量更高,可在临床推广选用。Objective To compare the efficacy of general anesthesia and combined general - epidural anesthesia in single - port laparoscopic sigmoid colon orthotopic neobladder construction. Methods 40 elderly patients with bladder cancer for selective laparoscopic radical eystectomy and detenial sigmoid colon orthotopic neobladder construction were in- eluded. All participants were randomly divided into general anesthesia group （ Group G） and combined general - epidural anesthesia group （Group GE）. The HR, MAP, CVP, airway pressure （Paw） , PET CO2, PaCO2, pH, serum glucose （Glu） and Narcotrend index were recorded before anesthesia, 5 rain before pneumoperitoneum （T1） ; 10 min （T2） , 30 min （T3）, 90 min （T4） and 180 min （T5） after pneumoperitoneum; 30 rain （T6） after the removal of pneumoperitone- um; and at the termination of the operation （T7）. The durations of operation and pneumoperitoneum, bleeding volume, a- mount of propofol and remifentanil, time course of tracheal extubation and analepsia after drug withdrawal, and postopera- tive agitation incidence were also recorded. Results Significant elevations of HR, MAP, CVP, Paw, PETCO2 and Glu with reduction in pH were revealed in the both groups after pneumoperitoneum （ P 〈 0. 05 ） ; while it was significantly more prominent in HR and MAP at T2, T3, T6 and T7, as well as Glu at T2 - T7 in Group GE （ P 〈 0. 05 ）. The amount of remifentanil, the time course of tracheal extubation and the postoperative agitation incidence were significantly lower in Group GE （ P 〈 0.05）. Conclusion Compared with general anesthesia, combined general - epidural anesthesia in elder- ly patients underwent laparoscopic sigrnoid colon orthotopic neobladder construction leads less nociceptive stimulus reaction and more stable hemodynamics in the initial stage and after the removal of pneumoperitoneum. Furthermore, the combined general - epidural anesthesia can reduce the amount of opioids and the postoperative agitation incidence.

关 键 词：全身麻醉 硬膜外阻滞 单孔 腹腔镜 乙状结肠新膀胱术 

分 类 号：R699.5[医药卫生—泌尿科学]