摘要
目的：比较两种麻醉方法对小儿腹腔镜疝修补术（1aparoscopic herniorrhaphy，LH）应激反应的影响。方法：ASAI～Ⅱ级择期行LH息儿60例，年龄1～5岁，随机分为骶麻复合丙泊酚静脉全麻组（C组）和气管内插管全麻组（G组）各30例。检测术中不同时点血浆皮质醇（Cor）、去甲肾上腺素（NE）、肾上腺素（E）、促肾上腺皮质激素（ACTH）水平，并观察平均动脉压（MAP）和心率（HR）的变化，检测动脉血气，记录术后恢复情况及麻醉费用。结果：C组气腹后各时点Cor、NE、E、ACHT水平与气腹前的差异无显著性（P〉0．05），G组气腹后上述各指标显著高于气腹前（P〈0．05），且显著高于C组同时点（P〈0．05）。与气腹前比较，C组气腹后MAP及HR变化差异无显著性（P〉0．05），G组显著升高（P〈0．05），两组息儿气腹30min后PaCO：均显著增加（P〈0．05），停气腹后恢复至气腹前水平。C组麻醉苏醒时间明显快于G组[（14，7±4．9）minvs（22．1±5．4）min，t=-5．583，P=0．000]；C组术后镇痛需求率显著低于G组（5／30vs13／30，x^2=5．079，P=0．024），术后恶心、呕吐发生率差异无显著性（6／30vs11／30 ,x^2=2．052，P=0．152）；C组麻醉费用比G组明显减少[（599±62）元vs（1964±238）元，t=-30．504，P=0．000]。结论：骶麻复合丙泊酚静脉全麻可有效抑制小儿LH围术期的应激反应且经济安全，患儿术毕苏醒质量改善。
Objective To compare the effect of two different anesthesia on stress reactions in children receiving laparoscopic herniorrhaphy. Methods Sixty children, aged 1 to 5 years old and scheduled for laparoscopic herniorrhaphy （LH） , were randomly divided into two groups, either receiving caudal block combined with propofol intravenous administration （ Group C, 30 cases） or general anesthesia （Group G, 30 cases）. The concentrations of cortisol （Cor） , norepinephrine （ NE ） , epinephrine （ E ） , and adrenocorticotrophic hormone （ACTH） at the different time were measured. The variations of mean artery pressure （MAP） and heart rate （HR） during operation were observed. And the arterial blood gas, postoperative recovery, and anesthetic expenses were also evaluated. Results As compared with preoperative levels, the concentrations of Cor, NE, E, and ACTH had no significant changes after COs pneumoperitoneum in the Group C （P 〉 0.05） , while were significantly increased in the Group G （P 〈 0.05） , which were also significantly higher than those in the Group C at the every time points. After pneumoperitoneum, the MAP and HR were unchanged in the Group C （P 〉 0.05） while remarkably increased in the Group G （P 〈 0.05）. In both of groups, the PaCO2 levels were significantly increased 30 min after pneumoperitoneum （P 〈 0.05 ） and gradually dropped down to normal levels after the removal of pneumoperitoneum. The recovery time from anesthesia was significantly shorter in the Group C than in the Group G （ 14.7 ± 4.9 min vs 22.1± 5.4 min; t = -5. 583 ,P = 0. 000）. The postoperative analgesia requirement was significantly less in the Group C than in the Group G （5/30 vs 13/30; X^2 =5. 079, P =0. 024）. No significantly differences were seen in incidences of nausea and vomiting between the two groups （6/30 vs 11/30; X^2 =2. 052, P =0. 152）. The Group C had significantly lower anesthetic expenses than the Group G （599 ± 62 yuan vs 1964 ± 238 yuan ; t = - 30. 504, P = 0. 000）. Conclusions As compared with general anesthesia, caudal block combined with propofol intravenous administration can be applied more economically and more safely to ASA Ⅰ～Ⅱ grade children receiving laparoscopic herniorrhaphy, and can more effectively inhibit stress reactions and improve postoperative recovery.
出处
《中国微创外科杂志》
CSCD
2007年第6期545-547,共3页
Chinese Journal of Minimally Invasive Surgery
关键词
小儿
骶管阻滞
腹腔镜疝修补术
全身麻醉
应激反应
Child
Caudal block
Laparoscopic herniorrhaphy
General anesthesia
Stress reaction
