全麻复合硬膜外麻醉在腹腔镜直肠癌根治术中应用探究.docVIP

全麻复合硬膜外麻醉在腹腔镜直肠癌根治术中应用探究 　【摘要】目的：评价全麻复合硬膜外麻醉在腹腔镜直肠癌根治术中的应用效果及安全性。方法：40例ASAⅠ~Ⅱ级择期行腹腔镜直肠癌根治术的病人，随机分为A组和B组各20例。A组为全麻复合硬膜外麻醉组，B组为单纯全麻组，分别观察两组病人手术期血流动力学变化、血气变化及全麻药用量。结果：两组病人手术期各时段HR、MAP变化A组均较B组轻且平稳；两组病人血气分析PaO2、HCO3均明显高于术前（P＜0.01），但两组无明显差异；A组全麻药用量明显小于B组（P＜0.01）。结论：全麻复合硬膜外麻醉用于腹腔镜直肠癌根治术较单纯应用全身麻醉，全麻药用量明显减少，循环呼吸功能平稳，且便于术后镇痛。 【关键词】麻醉，全身#12539;麻醉，硬膜外#12539;腹腔镜#12539;结直肠外科手术 General combined with epidural anesthesia for laparoscopicassisted rectectomy 【ABSTRACT】Objective:To evaluate the safety and efficacy of laparoscopicassisted rectectomy under combined general and epidural anesthesia.Methods:Forty ASA Ⅰ~Ⅱ patients scheduled for selective laparoscopicassisted rectectomy were randomly divided into two groups:group A and group B.Group A received combined general and epidural anesthesia and group B received general anesthesia only.Hemodynamics changes,PaO2 HCO-3 and anesthetic doses were observed preoperation,perioperation and postoperation.Results:The changes of HR,MAP in group A were lower than that of group B.PaO2,HCO3 were significantly higher than that of preoperation(P＜0.01),but there were no significant difference between the two groups.The anesthetic doses of group A were significantly lower than that of gorup B（P＜0.01）.Conclusion:Comparing to general anesthesia,combined general and epidural anesthesia can significantly reduce the anesthetic doses,use PECA conveniently and have no significant reverse effect on circulation and respiratory.So combined general and epidural anesthesia is the best choice for laparoscopicassisted rectectomy. 【KEY WORDS】Anesthesia,general#12539;Anesthesia,epidural#12539;Laparoscopes#12539;Colorectal Surgery 腹腔镜技术用于结直肠癌治疗的效果已被肯定［1］，但腹腔镜直肠癌根治手术以往多采用气管内插管全身麻醉，我院自2003年以来采用全麻复合硬膜外麻醉的方法，取得了较好的麻醉效果，现报告如下。 1 资料与方法 1.1 一般资料 　　 腹腔镜直肠癌根治术40例，年龄37~61岁，男24例，女16例，体重45~71kg，ASAⅠ~Ⅱ。随机分为两组，每组20例，A组为全麻复合硬膜外阻滞组，B组为全身麻醉组。两组年龄、体重具有可比性。见表1。表1 两组一般资料和手术时间 　　1.2 麻醉方法 术前均肌注苯巴比妥钠0.1g，阿托品0.5mg。A组：于T12~L1行硬膜外穿刺置管，注入试验量2%利多卡因4ml，确定在硬膜外腔后开始全麻诱导，面罩吸氧，静注安定0.1mg/kg、芬太尼