全身麻醉联合硬膜外阻滞麻醉对腹腔镜胆囊切除术患者应激反应的影响  

The influence of general combined epidural anesthesia on stress reaction in patients with laparoscopic gallbladder resection

作　　者：金理照 丁梯杰 Jin Lizhao Ding Tijie(Department of Anesthesia,the Peoples Hospital of Cangnan County,Zhejiang 325800, Chin)

机构地区：[1]浙江省苍南县人民医院麻醉科,325800

出　　处：《中国基层医药》2016年第24期3794-3797,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的：比较全身麻醉联合硬膜外阻滞麻醉和单纯全身麻醉用于腹腔镜胆囊切除术对患者术中循环和应激反应的影响。方法行腹腔镜胆囊切除术择期手术患者60例，采用随机数字表法分为全身麻醉复合硬膜外阻滞麻醉组（A 组）和全身麻醉组（B 组），每组30例，比较两组麻醉前5 min（T0）、气腹后15 min （T1）、和停气腹后10 min（T2）的 MAP、HR、C-反应蛋白（CRP）、肾上腺素（E）和去甲肾上腺素（NE）浓度。结果 B 组 T1时的 MAP 和 HR[分别为（95．4±4．6）mmHg、（90．5±12．2）次／min]明显高于 A 组[分别为（87．1±6．0）mmHg、（83．2±13．5）次／min]（t1＝7．81，t2＝6．98，均 P ＜0．05）；B 组 T1、T2时的 E、NE 和 T2的CRP[分别为（242．1±40．5）ng／L、（271．5±31．5）ng／L、（238．0±41．8）ng／L、（265．1±40．6）ng／L、（39．3±3．9）mg／L]均明显高于 A 组[分别为（195．7±28．0）ng／L、（236．9±20．3）ng／L、（191．3±31．8）ng／L、（239．2±34．2）ng／L、（26．3±3．8）mg／L]（t1＝10．02，t2＝8．06，t3＝9．42，t4＝8．69，t5＝9．48，均 P ＜0．05）；A 组术后清醒及拔管时间[分别为（7．2±0．8）min、（11．2±7．3）min]明显短于 B 组[分别为（16．4±0．8）min、（18．8±0．4）min]（t1＝9．81，t2＝9．60，均 P ＜0．05）。结论相对于单纯全麻，全麻复合硬膜外阻滞则能较好地抑制术后应激反应。Objective To compare the effects of general anesthesia combined with epidural space block anesthesia and pure general anesthesia on intraoperative circulation and stress reaction in patients with laparoscopic cholecystectomy.Methods 60 patients undergoing elective surgery of laparoscopic cholecystectomy were randomly divided into general anesthesia compound epidural group （group A）and general anesthesia group （group B）, 30 cases in each group.The MAP,HR,C -reactive protein （CRP）,epinephrine （E）and norepinephrine （NE） concentrations in the two groups at 5 min before anesthesia （T0）,15min after the pneumoperitoneum （T1）,and stop 10 min after pneumoperitoneum （T2）were compared.Results T1 MAP and HR in group B[（95.4 ±4.6）mmHg, （90.5 ±12.2 ）times/min]were significantly higher than those in group A [（87.1 ±6.0 ）mmHg,（83.2 ± 13.5）times/min]（t1 =7.81,t2 =6.98,all P 〈0.05）.In group B,the E and NE levels at T1,T2 and CRP level at T2[（242.1 ±40.5）ng/L,（271.5 ±31.5）ng/L,（238.0 ±41.8）ng/L,（265.1 ±40.6）ng/L,（39.3 ±3.9）mg/L] were significantly higher than those of group A[（195.7 ±28.0）ng/L,（236.9 ±20.3）ng/L,（191.3 ±31.8）ng/L, （239.2 ±34.2）ng/L,（26.3 ±3.8）mg/L]（t1 =10.02,t2 =8.06,t3 =9.42,t4 =8.69,t5 =9.48,all P 〈0.05）. The sober and postoperative extubation time of group A[（7.2 ±0.8）min,（11.2 ±7.3）min]were significantly shorter than group B[（16.4 ±0.8）min,（18.8 ±0.4）min]（t1 =9.81,t2 =9.60,all P 〈0.05）.Conclusion Compared with the pure general anesthesia,general anesthesia compound epidural block can inhibit the postoperative stress reaction.

关 键 词：胆囊切除术 腹腔镜 麻醉 硬膜外 麻醉 全身 急相反应 

分 类 号：R614[医药卫生—麻醉学]