不同麻醉方法对二氧化碳气腹致应激激素和循环功能的影响

目的：观察比较全麻和全麻复合硬膜外麻醉在腹腔镜胆囊切除术（LC）时,对CO2气腹致应激激素和循环功能的影响。方法：40例LC患者随机分为全麻组（A组,n=20）和全麻复合硬膜外麻醉组（B组,n=20）,连续监测SBP、DBP、MAP、HR、ECG、SpO2、PETCO2,记录两组患者麻醉前（T1）、插管后（T2）、气腹后10min（T3）、气腹后20min（T4）和放气后10min（T5）的SBP、DBP、MAP、HR、同时抽静脉血测定血糖（Glu）、血浆皮质醇（Cor）、促肾上腺皮质激素（ACTH）和血管紧张素-Ⅱ（AT-Ⅱ）。结果：T1时两组所有检测值比较差异无显著性（P＆gt;0.05）;在T2、T3、T4、T5时A组SBP、DBP、MAP值明显升高,B组较基础值下降,组间差异显著（P＆lt;0.05）;气腹建立后A组HR,Glu、Cor、ACTH、AT-Ⅱ明显上升（P＆lt;0.05）,B组无显著变化（P＆gt;0.05）,（除ACTH外）组间差异显著（P＆lt;0.05）。结论：全麻复合硬膜外麻醉用于LC手术时,能相对更好的的抑制CO2气腹所致应激激素的升高,使循环更稳定。

Stress hormones and hemodynamic change during and after Carbon dioxide pneumoperitoneum under general anesthesia and general-epidural combined anesthesia

Objective： To observe stress hormones and hemodynamic change during and after Carbon dioxide pneumoperitoneum in laparoscopic cholecystectomy （LC） under general anesthesia and general- epidural combined anesthesia. Methods： 40 patients of LC were divided into general anesthesia group （A group n=20） and general- epidural anesthesia group （B group n=20） randomly. All patients＇SBP, DBP, MAP, HR, ECG, SpO2, PETCO2 are monitored continuously. Record SBP, DBP, MAP, HR before anesthesia, after tracheal intubation, at 10min 20min after pneumoperitoneum and at 10min after the removal of pneumoperitoneum, meanwhile, plasma concentration of blood glucose （Glu）, cortisol （Cor）, adrenocorticotropin （ACTH）and angiotensin II （AT- II ）were measured. Results： Before anesthesia,all measured value did not differ much between group A and group B （P 〉0.05）; after tracheal intubation, at 10min 20min after pneumoperitoneum and at 10min after the removal ofpneumoperitoneum, SBP,DBP,MAP in group A increased significantly than those in group B （P 〈0.05）;HR and the concentrations of Glu, Cor, ACTH, AT- II were increased significantly after peritoneal insuftlation of CO2 in group A （P 〈 0.05 ）, while there were no changes in group B （P 〉 0.05）. There was difference between two groups （except for ACTH）（P 〈0.05 ）. Conclusion： There was a relative advantage in reducing the stress hormones caused by Carbon dioxide pneumoperitoneum and stabilizing the hemodynamic in LC under general- epidural anesthesia.