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两种麻醉方法对腹腔镜气腹的血液动力学和应激反应变化的作用 |
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王泉云 王健 罗方武
【摘要】 目的 观察全身麻醉和全麻复合硬膜外麻醉用于腹腔镜胆囊切除术(LC)中，CO2气腹对血液动力学和血浆儿茶酚胺浓度的影响。方法 20例行腹腔镜胆囊切除患者，随机分成全麻组(A组，11例)和硬膜外＋全麻组(B组，9例)，采用Swan-Ganz导管技术，监测气腹时血液动力学变化，用高效液相色谱——电化学检测气腹前后血浆肾上腺素(E)和去甲肾上腺素(NE)浓度。结果 (1)血浆NE、E浓度变化：气腹时A组均明显增加(P＜0.05)，B组无明显变化(P＞0.05)；(2)血液动力学变化：气腹时A组HR、MAP、CVP、SVR及CI均明显增加，SV无明显变化；B组除CVP明显上升外，其余各指标均无明显变化。结论 全麻复合硬膜外麻醉下施行LC，能减轻术中应激反应，稳定血液动力学。
【关键词】 麻醉，硬膜外 麻醉，全身 胆囊切除术，腹腔镜 血液动力学 应激
Hemodynamics and stress response changes during laparoscopic cholecystectomy under general anesthesia or combination of general and epidural anesthesia
WANG Quanyun，WANG Jian，LUO Fangwu.
Departmeot of Anesthesiology，West China University of Medical Sciences，Chengdu 610041
【Abstract】 Objective To observe the hemodynamic and concentration of plasma catecholamines changes during laparoscopic cholecystectomy (LC) under general anesthesia or combined with epidural anesthesia.Methods Twenty patients，scheduled for LC，were randomly divided into general anesthesia group (A group，n=11) and general anesthesia combined with epidural anesthesia group (B group，n=9).The hemodynamic changes after peritoneal insufflation of CO2 were measured with Swan-Ganz catheterization，and the plasma concentration of epinepherine (E) and nonepinepherine (NE) were measured before and after CO2 being insufflated into peritoneal cavity with high performance liquid chromatography-electrochemical method.Results (1) Both concentraitons of NE and E were increased significantly after peritoneal insufflation in A group (P＜0.05)，while no obvious changes in B group (P＞0.05).(2)HR，MAP，CVP，SVR and CI were increased significantly while SV had no obvious change after peritoneal insufflation in A group； in B group， all parameters had no significant changes except CVP was significantly increased.Conclusion The combination of general and epidural anesthesia can suppress the stress response and stablize the hemodynamics during LC.
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