不同麻醉方法对腹腔镜子宫切除术病人气腹应激的临床观察.doc

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1、不同麻醉方法对腹腔镜子宫切除术病人气腹应激的临床观察【摘要】目的观察全麻复合硬膜外麻醉与单纯气管内全麻对腹腔镜子宫切除手术病人气腹应激的影响。方法对44例腹腔镜子宫切除术患者应用单纯气管内全麻（A组），并与同期44例全麻复合硬膜外麻醉患者（B组）进行比较。观察其对子宫切除术患者循环和皮质醇与醛固酮水平的影响。结果两组年龄、体重、ASA分级、并发症比较差异均无统计学意义(P>0.05)。A组收缩压（SBP）、平均动脉压（DBP）、心率（HR）在气腹后明显高于入室麻醉后术前稳定时水平(P<0.05)，尤其DBP、HR均高于B组同一时段的

2、水平(P<0.05)。而B组术中SBP、DBP、HR均稳定于入室麻醉后术前稳定时水平。A组在腹腔镜子宫切除术气腹后皮质醇、醛固酮水平较入室麻醉后术前稳定时显著升高(P<0.01)，且显著高于B组(P<0.05)。B组两者改变不显著(P>0.05)。结论全麻复合硬膜外麻醉可通过有效阻断交感神经的传导通路，降低气腹对腹腔镜子宫切除术气腹应激的影响，保持皮质醇与醛固酮水平和循环功能稳定。【关键词】麻醉气腹应激　　ClinicalObservationofAbdominalStressinPatientsTreatedwith

3、LaparoscopicHysterectomybyDifferentAnesthesia　　Abstract：ObjectiveToobservetheeffectonabdominalstressinlaparoscopichysterectomypatientsbygeneralanesthesiacombinedwithepiduralanesthesiaorbysimpleendotrachealanesthesia.MethodsThechangesincirculation,hydrocortisoneandaldosteronew

4、ereobservedin44patientsbysimpleendotrachealanesthesia(GroupA)andanother44patientsbygeneralanesthesiacombinedwithepiduralanesthesia(GroupB).Therewerenosignificantdifferencesbetweenthetwogroupsinage,bodyweight,ASAclassificationandcomplication(P>0.05).ResultsInGroupA,systolic

5、bloodpressure(SBP),digitalbloodpressure(DBP)andheartrate(HR)weresignificantlyhigherafteraeroperitoniathanduringthetimeofanesthesiatilloperation(P<0.05),andespecially,DBPandHRofGroupAwerehigherthanthatofGroupBatthesametime(P<0.05).HydrocortisoneandaldosteroneinGroupAwere

6、significantlyhigherafteraeroperitoniathanduringthetimebetweenanesthesiaandsurgery(P<0.01),andweresignificantlyhigherthanthatinGroupB(P<0.05).ButthetwoparameterswerenotsignificantlychangedinGroupB(P>0.05).ConclusionThepassagewayofconductionmaybeobstructedbygeneralanes

7、thesiacombinedwithepiduralanesthesia,whichmaycutdowntheeffectofabdominalstressandmaintainthestabilizationofhydrocortisone,aldosteroneandcirculationfunctioninlaparoscopic4hysterectomy.　　Keywords：anesthesia;aeroperitonia;stress　　全麻下行腹腔镜妇科手术时，术中气腹对手术应激和循环功能干扰甚大［1］，因此对腹腔镜麻醉管理提出了新

8、的思考。本组通过测定入室麻醉后术前稳定时和气腹后的皮质醇、醛固酮水平和循环功能的变化，对硬膜外复合全麻和单纯气管内全麻方法进行比较，来