摘要
目的:比较单纯全麻与硬膜外复合全麻在腹腔镜子宫切除术中的麻醉效果。方法:选择ASA级或级择期行腹腔镜子宫切除术患者30例,随机均分为单纯全麻组(G组)与硬膜外复合全麻组(EG组)。G组麻醉维持用依托咪酯脂肪乳注射液、瑞芬太尼、维库溴铵和异氟醚吸入,EG组采用全麻复合硬膜外阻滞。于麻醉前10 min(T0)、气腹后10 min(T1)及停气腹后5 min(T2)3个时间点,采集静脉血测定血糖(BG)、儿茶酚胺(CA),C反应蛋白(CRP)和白介素6(IL-6)浓度,并观察呼吸和循环指标。记录两组患者术中静脉麻醉用药量及术后完全清醒时间、拔管时间及清醒质量。术中由手术医师对子宫松弛度进行评级(优、良、差)。结果:与G组相比,EG组各时点气道平均压(MAP),心率(HR),BG,CA,CRP和IL-6显著降低(P<0.05),子宫松弛度优(P<0.01),麻醉用药量明显减少(P<0.01),术毕清醒、拔管时间明显缩短(P<0.01),术后清醒质量明显优于G组(P<0.01)。结论:与单纯G组比较,EG有利于抑制腹腔镜手术中的应激反应,使全麻药用量减少,苏醒及拔管时间缩短,子宫松弛满意,利于手术操作。
Objective：To compare the cost-effectiveness of simple general anesthesia and general anesthesia combined with epidural block in patients during laparoscopic hysterectomy. Methods ：Thirty ASA Ⅰ or Ⅱ patients scheduled for laparoscopic hysterectomy were randomly divided into two groups：group G simple general anesthesia and goup EG general anesthesia combined with epidural block,Group G was anaesthetized with etomidate fat emulsion injection, remifentanil ,vecuronium and isoflurane. Goup EG used general anesthesia combined with epidural block. Blood samples was taken from patients in each group in 10 min before anesthesia （T0）, 10 min after pneumoperitoneum（T1）, 5 rain after the end of pneumoperitoneum（T2） ,to determine the glucose （BG） ,catecholamine（CA） ,C-response protein （CRP） and the consistence of interleukins-6 （IL-6）. The index of the breathe and circulate were also recorded. The amount of intravenous anesthesia and postoperative awake time ,extubation time and the quality of consciousness were recorded. The degree of uterine relaxation will be divided into three ratings （excellent ,good,bad）. Results ：Group EG at each time point MAP,HR,BG,CA,CRP and IL-6 were significantly lower than the Group G（P〈0. 05）,uterine relaxation was better than the G group（P〈0. 01） ,the dosage of anesthesia was lower than the Group G（P〈0. 01）. The recovery time and extubation time were significantly shorter ,less anesthetics were consumed and the conscious quality was better in group EG than in group G （P〈0. 01 ）. Conclusion：The stress response is more effectively controlled,less anesthetics are consumed and the awake time and extubation time are shorter after operation in group EG than in group G,while in group EG the degree of uterine relaxation is better than the group G.
出处
《临床医药实践》
2010年第11期803-805,共3页
Proceeding of Clinical Medicine
关键词
全麻
硬膜外复合全麻
腹腔镜子宫切除术
应激反应
general anesthesia
combined general epidural anesthesia
laparoscopic hysterectomy
stress response
