不同麻醉方法对腹腔镜手术患者应激反应及循环功能影响.docVIP

不同麻醉方法对腹腔镜手术患者应激反应及循环功能影响 　 作者：张春燕 潘晓军 汤述海 任萍 舒雅 【摘要】 　　目的: 观察比较全麻和全麻复合硬膜外麻醉对腹腔镜胆囊切除手术患者应激反应和循环功能的影响。方法: 28例腹腔镜胆囊切除术（LC）患者随机分为全麻组（G组）和全麻复合硬膜外麻醉组（GE组），监测气腹前后HR、SBP、DBP、MAP、血浆肾上腺素(E)、去甲肾上腺素（NE）、血糖、皮质醇浓度及血气分析变化。结果: 两组HR、SBP、MAP均有不同程度的升高，G组较GE组显著；G组E、GE、血糖均显著升高，GE组无显著变化，两组间差异有统计学意义；两组皮质醇均显著升高,组间差异有统计学意义；两组气腹后均出现PaCO2升高，pH降低，差异无统计学意义。结论: LC手术中全麻复合硬膜外麻醉引起的应激反应轻，对循环功能影响小。 【关键词】 麻醉，全身　麻醉，硬膜外　胆囊切除术·腹腔镜·应激·血流动力学 　　Stress response and hemodynamic change during laparoscopic cholecystectomy under general anesthesia and general-epidural combined anesthesia 【ABSTRACT】 Objectives: To observe the stress response and hemodynamic change during laparoscopic cholecystectomy (LC) under general anesthesia and general-epidural combined anesthesia. Methods: 28 patients of LC were divided into general anesthesia group (G group n=14) and general-epidural anesthesia group(GE group n=14) randomly. The HR、SBP、MAP, plasma concentration of epinephrine(E), norepinepherine (NE), blood glucose、cortisol, PaCO2 and pH were measured before and after peritoneal insufflation of CO2. Results: The HR, SBP and MAP were increased significantly in group G than those in group GE(Plt;0.05). The concentrations of E, NE and blood glucose were increased significantly after peritoneal insufflation of CO2 in group G, while there were no changes in group GE. The concentration of cortisol was increased significantly in both groups. The increasing of PaCO2 and decreasing of pH were all appeared after peritoneal insufflation of CO2. Conclusions: The stress response and hemodynamic changes were slighter during LC under general-epidural anesthesia than general anesthesia. 【KEY WORDS】 Anesthesia，general·Anesthesia，epidural·Cholecystectomy，laparoscopic·Stress ·Hemodynamics 　　腹腔镜胆囊切除术（Laparoscopic cholecystectomy, LC）因其手术创伤小、术后疼痛轻、恢复快、住院时间短等优点已被临床广泛应用。本研究观察全麻和全麻复合硬膜外两种麻醉方法对腹腔镜胆囊切除患者应激反应和循环功能的影响。 1　资料与方法 1.1　一般资料　2006年3月~5月，山东大学齐鲁医院腹腔镜手术室行 LC28例，男9例，女19例，年龄40~51岁。ASA（美国麻醉医师协会病情估计分级）I~II级，无重要器官合并症，无内分泌系统疾患。随机分为全麻组（G组）和全麻复