硬膜外阻滞麻醉下腹腔镜胆囊切除术对血流动力学影响的初步观察  

HEMODYNAMIC CHANGES DURING LAPAROSCOPIC CHOLECYSTECTOMY UNDER EPIDURAL ANESTHESIA

作　　者：杜景平[1] 王健[1] 刘宗琼 张红霞 朴彩云 赖力[1] 罗泽[2] 罗芳 

机构地区：[1]华西医科大学附属第一医院,四川成都610041 [2]广元市急救中心,四川广元628000 [3]江津市人民医院,四川江津632260

出　　处：《中国现代普通外科进展》1999年第2期30-33,共4页Chinese Journal of Current Advances in General Surgery

摘　　要：目的 观察硬膜外阻滞麻醉下腹腔镜胆囊切除术对血液动力学的影响.方法 随机选择25例ASA-Ⅰ～Ⅱ级的腹腔镜胆囊切除术(LC)病人,分成硬膜外麻醉组(n=14)和全麻组(n=11),初步观察和监测麻醉后、改变为头高足低位后、气腹后以及术毕等各时点血流动力学指标(HR、MAP、CVP、MPAP、PCWP、CO、CI、SVR及PVR)的变化.结果 麻醉后硬膜外麻醉组仅SVR明显降低;改变为头高足低位后,两组CVP均下降;气腹后,硬膜外麻醉组HR、MAP、SV和CO均明显下降,但尚能维持在正常低限水平,而SVR在麻醉后下降的基础上有明显增加.全麻组气腹后,除SV无明显变化外,其余指标均明显增加.结论 LC可常规选择性地采用硬膜外阻滞麻醉,但对有心肺功能障碍、年老体弱或过分肥胖的病人以及手术难度大、费时久的病人仍宜选用全麻甚至改行传统开腹手术为宜.Objective : To observed the hemodynamic changes of laparoscopic chole-cystectomy (LC) patients under epidural anesthesia comparing with those under general anesthesia, and to evaluated the advantages and the disadvantages of them. Methods : Twenty-five patients with ASA-Ⅰ - Ⅱgrade were divided into two groups: genera I anesthesia group(n = 11)and epidurai anesthesia group(n = 14).Hemodynamic parameters(HR, MAP,CVP,PAP, CP and computed Cl, SVR, PVR) were monitored at the time from after anesthesia to the end of LC. Results : ①In both groups, CVP reduced significantly after revered position;②In the epidurai anesthesia group, HR.MAP, CO, SV reduced significantly after pneumoperitoneum,but still within normal range;③In the general anesthesia group, after pneumoperitoneum, all parameters were significantly increased except SV had no significant change. Conclusion : Epidural anesthesia can be safely applied to the ASA-Ⅰ- Ⅱgrade patients undergoing LC as conventional anesthesia.

关 键 词：胆囊切除术 腹腔镜 血流动力学 硬膜外阻滞麻醉 LC 

分 类 号：R657.4[医药卫生—外科学] R614.42[医药卫生—临床医学]