全麻复合硬膜外阻滞与单纯全麻用于腹腔镜胆囊切除术的比较研究  

A comparison of general anesthesia with combined general epidural anesthesia used for laparoscopic cholecystectomy

作　　者：唐小林[1] 李国安[2] 冯涛[1] 邓艳玲[1] 周维新[3] 张小芳[4] 

机构地区：[1]湖南省永州市人民医院麻醉科,425006 [2]湖南省永州市人民医院外科,425006 [3]湖南省永州市人民医院检验科,425006 [4]湖南省永州市人民医院手术室,425006

出　　处：《临床麻醉学杂志》2001年第2期77-79,共3页Journal of Clinical Anesthesiology

摘　　要：目的　比较异丙酚全麻复合硬膜外和单纯异丙酚全麻用于腹腔镜胆囊切除术 (LC)对BP、HR、血儿茶酚胺、皮质醇和血气等的影响。方法　 44例行LC患者随机分成异丙酚全麻组 (A组 ,2 2例 )和异丙酚全麻复合硬膜外组 (B组 ,2 2例 )。术中连续监测HR、BP和SpO2 ,分别分时段测定血气及血肾上腺素 (E)、去甲肾上腺素 (NE)及皮质醇 (COS)浓度。结果　 (1)气腹时A组HR和BP均明显增加 (P <0 0 5 ) ;B组各指标无明显变化 (P >0 0 5 )。 (2 )气腹时两组PaO2 、HCO-3 均明显增高 (P <0 0 5 ) ,但两组间各指标无明显差异 (P >0 0 5 )。 (3)E、NE及COS浓度 ,气腹时A组有明显差异 (P <0 0 5 ) ;B组无明显变化 (P >0 0 5 )。结论　异丙酚全麻复合硬膜外用于LC时机体应激反应轻 ,是较理想的麻醉方法。Objective To compare the effect of propofol general anesthesia with combined general epidural anesthesia used for laparoscopic cholecycstectomy(LC)on BP,HR,plasma catecholamines,cortisol and blood gas.Methods Forty four patients undergoing LC were dividied into propofol general anesthesia group(group A, n= 22) and propofol general anesthesia combined with epidural anesthesia group(group B, n= 22).HR,BP and SpO 2 were monitored.Blood gas and the concentrstions of norepinephrine (NE),epinephine(E),and cortisol(COS) were measured.Results (1)HR,SBP,DBP and MAP were increased significantly( P< 0 05) during pneumoperitoneurn in group A,but not in group B( P> 0 05).(2)PaO 2 and HCO - 3 were increased significantly in two groups( P< 0 05),but had no significant difference between the two groups( P> 0 05).(3)The concentrations of NE,E and COS were increased significantly in group A during pneumoperitoneurn and at 10min after deflation,but not markedly changed in group B( P> 0 05).Conclusion Propofol general anesthesia combined with epidural anesthesia may alleviate the stress response to surgery and be an ideal technique for laparoscopic cholecystectomy.

关 键 词：硬膜外阻滞 全身麻醉 异丙酚 腹腔镜胆囊切除术 复合麻醉 比较 

分 类 号：R614[医药卫生—麻醉学]