摘要
目的通过对两种麻醉方式下行妇科腹腔镜手术患者氧代谢变化情况的对比观察,探讨异丙酚复合腰硬联合麻醉方式用于妇科腹腔镜手术的安全性、可行性。方法将30例ASAI^II级的患者随机分为两组A组15例为气管插管全麻组,B组15例为异丙酚复合腰硬联合麻醉组。两组均在局麻下行左侧桡动脉穿剌和右颈内静脉穿剌置漂浮导管。A组以咪唑安定5mg、依托咪酯0.1~0.3mg/kg、维库溴胺0.1mg/kg、芬太尼2~4μg/kg诱导插管,泵注异丙酚,间断给予维库溴铵、芬太尼维持麻醉平稳。B组择L2-3椎间隙硬膜外穿剌,针内针推注重比重盐酸布比卡因注射液10mg,留置硬膜外管备用,调整麻醉平面至T6水平,泵注异丙酚至患者意识消失即开始手术。分别于麻醉前、麻醉后、气腹后10、30、60min、术毕放气腹后15min抽取桡动脉血和混合静脉血进行血气分析,同时记录两组各时点脉搏氧饱和度(SpO2)、心率(HR)、平均动脉压(MBP)、肺动脉压(PAP)、肺动脉楔压(PCWP)、心排量(CO)、外周血管阻力(SVR)、气腹时间、不良反应,计算两组各时点的氧供(DO2)、氧需(VO2)及氧摄取率(ERO2)。结果两组患者DO2、VO2及ERO2各时点比较差异无统计学意义(P>0.05),与麻醉前基础值比较,两组麻醉后及气腹过程中VO2、ERO2均显著降低(P<0.05);B组术毕停气腹15min后VO2、ERO2均恢复至麻醉前水平。A组患者动脉二氧化碳分压(PaCO2)气腹过程中较麻醉前均有所增加,且术后15min未能恢复至麻醉前水平,但差异无统计学意义(P>0.05);B组麻醉后及气腹过程中PaCO2较麻醉前明显增高(P<0.05),气腹后30min比A组高(P<0.05),术毕15min下降至麻醉前水平。结论两种麻醉方法应用于ASAI^II级患者的妇科腹腔镜手术的临床麻醉效果均满意。异丙酚复合腰硬联合麻醉操作更简便,术后恢复较快,但气腹过程中有高碳酸血症风险,术中应加强监测和麻醉管理。
Objective To explore safety and feasibility of propofol and combined spinal-epidural anesthesia by investigating the oxygen metabolism under different anesthesia methods during gynecologic laparoscopy（GL）. Methods Thirty patients, ASA Ⅰ-Ⅱ, undergoing GL operation were randomly divided into general anesthesia group（group A, 15 patients）, propofol and combined spinal-epidural anesthesia group （group B, 15 patients）. Oxygen metabolism was measured by Swan-Ganz catheter method and reversible Fick＇s law re- spectively at 6 different time points：before anesthesia, after anesthesia, at 10,30,60 minutes after pneumoperitoneum and 15 minutes after peritoneal detlation. Results Oxygen delivery （ DO2 ）, oxygen consumption （ VO2 ） and oxygen extraction ratio（ ERO2 ）were variable slightly at the same point during the operation in group A and group B （P 〉 0.05 ）. VO2 and ERO2 decreased significantly after anesthesia and during pneumoperitoneum than those before anesthesia in two groups （ P 〈 0.05 ）, but VO2 and ERO2 came to the level before anesthesia at 15 minutes after peritoneal deflation in group B. PaCO2 increased shghtly during pneumoperitoneum than that before anesthesia in group A, and could not come to the level before anesthesia at 15 minutes after peritoneal deflation, but no significant difference was observed between group A and group B （ P 〉 0.05 ）. PaCO2 increased significantly after anesthesia and during pneumoperitoneum than that before an- esthesia in group B and at 30 minutes after pneumoperitoneuim in group A （ P 〈 0.05 ）, and decreased to the level before anesthesia at 15 minutes after operation. Conclusion The effect of two anesthesia methods used in GL are satisfied. The operation of propofol and combined spinal-epidural anesthesia is uncomplicated. Patients can relover to the level before anesthesia quickly, for the risk of hypereapnia probably exists during pneumoperitoneum, respiratory and circulation should be monitored continuously during the o
出处
《广西医学》
CAS
2007年第3期318-321,共4页
Guangxi Medical Journal
基金
广西卫生医疗科研课题(Z2005171)
