硬膜外阻滞加全麻在腹腔镜手术中应用.docVIP

硬膜外阻滞加全麻在腹腔镜手术中应用[摘要] 目的 探讨两种麻醉方法对LC患者的应激反应。方法 100例LC患者分为研究组(C组)和对照组(G组),分别采用硬膜外阻滞加全麻和全麻组,检测术前、术中、术后血糖,血胰岛素水平及生命体征和燥动率。结果 C组插管时平均动脉压,心率增高幅度较G组小,气腹后30min时血糖水平无明显变化,但均值G组较C组高,血胰岛素G组较术前低而C组较术前升高,燥动率G组大于C组。结论 硬膜处阻滞复合全麻用于LC手术能减轻机体在围手术期的应激反应。 [关键词] 硬膜外阻滞; 全身麻醉; 腹腔镜; 胆囊切除 [中图分类号] R614 [文献标识码] A [文章编号] 1673-9701(2009)23-101-02 Epidural Anesthesia and General Anesthesia in Laparoscopic Surgery HUANG Renyin LI Weidong Jingshan County People’s Hospital,Hubei 431800,China [Abstract] ObjectiveTo discuss patient stress response to two anaesthesia methods of LC. Methods100 examples weredividedinto C group and G group,to observe in front of in the examination technique,the technique,the technique the blood grain,the blood insulin level and the life symptom and the dry pace. ResultsMean arterial pressure intubation,heart rate of C group ofhigher than the G group is small,after 30 minutes the blood glucose has no significant changes,but the average G group than in C group,blood insulin G group than in the preoperative and the C group than in the low pre-operative higher fixed rate of dry G group than C group. ConclusionSubdural Department composite block anesthesia for surgery can reduce the body of LC in the perioperative stress response. [Key Words]Outside the hard membrane hinders; General anesthesia; Peritoneoscope 我们将100例择期腹腔镜胆囊切术患者随机分成研究组(C组)和对照组(G组),分别采用硬膜外阻滞加全麻、单纯全麻两种麻醉方法,以生命体征、血糖、血胰岛素变化、燥动率为监测指标,比较两种麻醉方法的应用效果及对机体的影响。 1 资料与方法 1.1 病例选择及分组 胆囊结石拟行择期腹腔镜胆囊切除术的患者100例,ASA Ⅰ～Ⅱ级。术前患者无明显心血管及内分泌异常,未使用过激素类药物。随机分为研究组(C组)及对照组(G组)各50例。两组患者基本情况见表1。两组患者年龄、体重、气腹时间、手术时间无明显差异(P0.05)。 1.2 麻醉方式及标本 术前48h禁用含糖液体及影响血糖及胰岛素指标的药物,患者于手术当日晨空腹抽取静脉血2mL后肌注苯巴比妥钠0.1g,阿托品0.5mg。麻醉诱导:依托咪酯0.3mg/kg,90～180s后气管插管,插管时间20～40s,全麻维持异丙酚200～300mg/h微量泵静脉注射,2%～3%氨氟醚吸入,术中间断静脉注射1/3～1/2首剂量万可松,维持肌松。研究组(C组)全麻诱导前于T8-9行硬膜外穿刺向上置管4～4.5cm,先给予3mL 1.73%碳酸利多卡因,无脊麻现象后追加2%盐酸利多卡因+0.5%盐酸布比卡因混合液7～15mL,测试平面达T6以下。术中依血流动力学变化情况调整液体速度。全麻中潮气量(Vt):8～12mL/kg,吸呼频率(F):14bpm,呼吸比(I∶E)=1∶1.5,CO2气腹实施以先慢后快方式,使腹腔内压达12