摘要
目的比较全身麻醉和腰硬联合阻滞麻醉（combined spinal anesthesia,CSEA）下悬吊式腹腔镜手术对患者血流动力学及血清酶学的影响。方法择期妇科悬吊式腹腔镜手术患者52例,ASAⅠ-Ⅱ级,年龄35-65岁。按麻醉方式不同分为全麻组和腰硬组两组,每组26例,分别于麻醉前、麻醉后、悬吊后10 min、悬吊后30 min、解除悬吊后10 min、拔管后等时点监测并记录患者MAP、HR、CVP、SpO2等指标,并比较手术前、后血清酶的变化。结果全麻组患者MAP无显著变化,腰硬组患者MAP在悬吊后10 min显著低于麻醉前水平;腰硬组患者MAP在悬吊后10 min显著低于全麻组;全麻组HR在麻醉诱导后显著低于麻醉前水平,腰硬组HR无显著变化;全麻组CVP在麻醉后显著高于麻醉前水平,腰硬组患者CVP在悬吊后10 min显著高于麻醉前水平,组间比较腰硬组患者CVP在麻醉后各时点显著低于全麻组;全麻组患者术后LDH和ALP显著升高（P〈0.05）,而腰硬组患者术后仅ALP较术前显著升高,全麻组术后LDH显著高于腰硬组。结论两种麻醉方法均可满足悬吊式腹腔镜手术的需要,但腰硬联合阻滞麻醉对患者循环系统的影响更小,同时减少了麻醉用药和对血清酶学的影响。
Objective To study the effects of gasless laparoscopy under general anaesthesia or combined spinal-epidural anaesthesia on hemodynamics and serum ferment in gynecological patients. Methods Fiftytwo patients, 35 -65 years-old, ASA Ⅰ - Ⅱ, who underwent gasless laparoscopy gynecological operation, were randomly divided into two groups： GA （general anaesthesia ） group and EPA ＋ LA （epidural anaesthesia ＋ lumbal anaesthesia） group, with 26 patients in each group. MAP, HR, CVP and SpO： were measured before and after anaesthesia, 10 min after suspension, 30 min after suspension, 10 min after removal of suspension, and after removal of extubation/epidural catheter, respectively. Serum ferment was measured prior operation and one day after operation. Results MAP varied in GA gcoup insignificantly, but decreased markedly in EPA ＋ LA group 10 min after suspension. MAP in EPA ＋ LA group was significantly lower than that of GA group 10 min after suspension. HR in GA group decreased markedly after anaesthesial induction, but remained stable in EPA ＋ LA group. CVP increased significantly in GA group after anaesthesia, so did in EPA ＋ LA group 10 min after suspension. CVP in EPA ＋ LA group was significantly lower than that of GA group at all time points. Both LDH and ALP increased significantly （ P 〈 0.05 ） after operation in GA group, but only ALP increased in EPA ＋ LA group. The post-operational LDH in GA group was significantly higher than that in EPA ＋ LA group. Conclusion Both general anaesthesia and combined spinal-epidural anaesthesia meet the requirements of gasless laparoscopy. However, the effects of gasless laparoscopy on patient＇ s hemodynamics under combined spinal-epidural anaesthesia are less significant than those under general anaesthesia. It demands less narcotics and causes less effects on serum ferment under combined spinal-epidural anaesthesia.
出处
《同济大学学报（医学版）》
CAS
2009年第5期90-92,96,共4页
Journal of Tongji University(Medical Science)
关键词
免气腹腔镜手术
循环功能
血清酶学
全身麻醉
腰硬联合阻滞
gasless laparoscopy
circulatory function
serum ferment
general anaesthesia
combined spinal-epidural anaesthesia
