两种硬膜外阻滞麻醉对腹腔镜手术血气分析影响.docVIP

两种硬膜外阻滞麻醉对腹腔镜手术血气分析影响 　【摘要】 目的：探讨单点和两点连续硬膜外阻滞麻醉方法对下腹部、盆腔腹腔镜手术血气分析的影响。方法：随机选择腹腔镜下行下腹部、盆腔手术患者46例平均分为A、B两组，A组实施L1～2间隙单点连续硬膜外阻滞麻醉，B组实施T9～10、L2～3两点间隙连续硬膜外阻滞麻醉，并作术中SpO2 、PaO2、PaCO2、PETCO2连续监测。结果：A组SpO2 、PaO2、PaCO2、PETCO2和B组PaCO2、PETCO2与麻醉前比较，均有显著性差异(P＜0.05)。组间比较SpO2、PaO2，有显著性差异(P＜0.05)，B组PaCO2、PETCO2比A组略低，但P＞0.05无显著性差异。结论：腹腔镜下行下腹部、盆腔手术时，两点连续硬膜外阻滞麻醉对呼吸功能的影响小，与单点连续硬膜外阻滞麻醉相比更值得临床应用。 【关键词】 麻醉，硬膜外；腹腔镜；血气分析 【Abstract】 Ｏbjective:To explore the effection of one interspace and two interspaces epidural block on the bloodgas analysis of laparoscopic surgery in lowerabdomen and pelvic cavity.Methods:46 patients undergoing laparoscopic surgery in lowerabdomen and pelvic cavity were randomly devided into two groups with A and B,group A received L12 while group B received T910、L23 interspaces contonious epidural anathesia.The data of SpO2,PaO2,PaCO2 and PETCO2 were recorded in the operation.Results:There were statistically significant differences between SpO2,PaO2,PaCO2,PETCO2 of group A and PaCO2,PETCO2 of group B compared with preoperation.Between the two groups,significant differences of SpO2 and PaO2 was observed,the data of PaCO2 and PETCO2 were lower than group A,but there were no significant differences.Conclusions:Two interspaces epidural block has a less effection on the breath of laparoscopic surgery in lower abdomen and pelvic cavity,so it has more advantanges than one interspace block. 【Key words】 Anesthesia,epidural;Laparoscopy；Bloodgas analysis 腹腔镜手术多在全麻下进行，近年来连续硬膜外阻滞麻醉下行腹腔镜手术的报道越来越多。两点间隙连续硬膜外阻滞麻醉（以下简称两点法）过去一般应用于腹部较大的手术，两点法阻滞麻醉用于腹腔镜手术的报道较少，我们作了23例行下腹部、盆腔腹腔镜手术两点法阻滞麻醉临床分析，并与单点连续硬膜外阻滞麻醉（以下简称单点法）下腹腔镜手术23例做了对比，分析了两种硬膜外阻滞麻醉对下腹部、盆腔腹腔镜手术血气分析结果的变化情况。现报道如下。 1 资料与方法 1.1 临床资料 选择我院拟在腹腔镜下行下腹部、盆腔手术的患者46例，ASAⅠ～Ⅱ级，男7例，女39例，18～65岁。其中卵巢囊肿摘除术21例，陈旧性宫外孕清除术6例，卵巢畸胎瘤摘除术12例，精索静脉高位结扎术7例。术前常规查体，无心肺疾患、脊柱畸形，常规禁饮食4～6h。 1.2 麻醉方法 术前30min肌肉注射鲁米那钠0.1g、阿托品0.5mg。A组实施L1～2间隙，B组实施T9～10、L2～3两点间隙，硬膜外穿刺，导管均头向置管4cm，固定稳妥后翻身改平卧位。两组均应用相同批号的局麻药配方。试验量1.73%碳酸利多卡因4ml，测试平面无异常后用2%利多卡因与0.75%布比卡因对半混合液维持麻醉，术中辅助麻醉药均静脉用哌氟