硬膜外阻滞复合全麻与单纯全麻用于腹腔镜肾上腺手术的比较  

COMPARISONS BETWEEN COMBINED GENERAL-EPIDURAL ANESTHESIA AND GENERAL ANESTHESIA IN LAPAROSCOPIC ADRENAL OPERATION

作　　者：徐建红[1] 阮进光[1] 孙建良 祝胜美[1] 

机构地区：[1]浙江大学医学院附属第一医院麻醉科,310003 [2]浙江省嘉兴市第一人民医院麻醉科,314000

出　　处：《中国内镜杂志》2003年第6期1-3,共3页China Journal of Endoscopy

摘　　要：目的 :比较硬膜外阻滞复合全麻与单纯全麻用于腹腔镜肾上腺手术对围术期血流动力学及术毕清醒时间等的影响。方法 :60例 (ASAⅠ～Ⅱ级 )肾上腺手术病人随机分为硬膜外阻滞复合全麻组 (GE组 ) (n =30 )与单纯全麻组 (G组 ) (n =30 ) ,两组诱导用药相同。GE组选择T9～ 1 0 或T1 0～ 1 1 行硬膜外穿刺置管 ,待硬膜外阻滞作用确切后开始诱导插管。G组术中持续吸入异氟醚 ,GE组连续输注异丙酚 ,硬膜外按需追加局麻药 ;两组均用维库溴铵维持肌松。分别于全麻诱导前 (或硬膜外注药后 )、诱导后、气管插管后、切皮、术中以及术毕记录HR及MAP值。术后观察并记录病人苏醒过程和时间。结果 :两组病人麻醉前基础HR、MAP均无显著性差别。全麻诱导后 ,两组病人HR、MAP与基础值相比有显著下降 ,GE组较G组下降更显著 (P <0 .0 5) ;气管插管后 ,G组于 1min、3min时HR增快 ,与基础值相比有显著性差别 ,而GE组HR始终保持在较稳定水平。G组插管后MAP有一过性增高 ,且在切皮、分离肾上腺或肿瘤、手术 1 .5h三个时点的HR、MAP均高于GE组 (P <0 .0 5) ;GE组插管后MAP仍略低于基础值 ,随后及术中MAP保持在基础值水平。术毕停药后 ,G组病人 (2 1 .8± 9.2 )min时可唤醒 ,而GE组病人 (6 .2± 3 .1 )min即可唤醒 ,两组间有显著性差?Objective:To compare the effects of combined general-epidural anesthesia(GEA) and general anesthesia(GA) in laparoscopic adrenal operation.Methods:Sixty patients (ASA class Ⅰ～Ⅱ) performed laparoscopic adrenal operations were randomly divided into 2 groups.Thirty cases were under GEA, while the others were under GA. In the GEA group, patients firstly received epidural blockade at T 9～10 or T 10～11 . Then after tracheal intubation, GEA group patients were maintained with propofol, vecuronium and epidural local anesthetics. While for GA group, they were with isoflurane and vecuronium. HR and MAP were recorded before induce (or after epidurally infusion), after induce, after intubation, skin incision, during operation and postoperation. And recovery time was observed. Results:There is no difference for MAP and HR for GEA and GA group before anesthesia, but both were decreased after induce. And for GEA group, there is significantly decrease ( P< 0.05). After intubation, HR was increased obviously for GA group, while GEA group patients were stable. During the operation, the hemodynamic (MAP, HR) of GEA group was more stable than GA group. The recovery quality of GEA group was better than GA group.Conclusion:Combined general-epidural anesthesia with propofol is better than general anesthesia in laparoscopic adrenal operation.

关 键 词：全身麻醉 硬膜外麻醉 腹腔镜手术 肾上腺手术 

分 类 号：R699.3[医药卫生—泌尿科学]