妇科腹腔镜手术两种麻醉方法的比较(1)
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【摘要】 目的 探讨妇科腹腔镜手术的两种麻醉方式、效果。方法 60例行妇科腹腔镜手术患者,随机分为全麻插管组(A组30例)和腰硬联合麻醉组(B组30例)。观察气腹效果、手术时间、呼吸,连续监测HR、SBp、DBp、SaO2,分时段抽动脉血行血气分析。结果 A组、B组气腹效果优良率分别为100%和80%;两组患者相同的病例手术时间(min)A组短于B组(P﹤0.05);两组患者呼吸比较,B组出现3例舌后坠或窒息,A组无;两组血气分析,B组气腹10min PaCO2、PaO2均明显高于麻醉前(P﹤0.05),A组气腹10min PaO2明显高于B组,组间比较差异有显著性(P﹤0.05)。结论 全麻插管静吸复合麻醉和腰硬联合麻醉均可用于妇科腹腔镜的手术,但腰硬联合麻醉适用于手术时间短的腹腔镜手术,在手术时间﹥1.5h的手术以气管插管控制呼吸为宜。
【关键词】 妇科;腹腔镜手术;麻醉
【中图分类号】R614.2+3 【文献标识码】 B 【文章编号】1005-0515(2010)007-028-03
[Abstract] Objective To investigate the anesthesia in gynecologic laparoscopy management. Methods 60 patients with a routine gynecological laparoscopic surgery, intubation anesthesia were randomly divided into group (A group of 30 cases) and combined spinal-epidural anesthesia group (B group of 30 cases). Observation of the effect of pneumoperitoneum, surgical time, breathing and continuous monitoring of HR, SBp, DBp, SaO2, arterial line at time pumping blood gas analysis. Results A group, B group pneumoperitoneum results were excellent and good rate of 100% and 80%; two cases of patients with the same operative time (min) A group of less than B group (P<0.05); compared two groups of patients with respiratory, Group B after the emergence of three cases of the tongue falling or suffocation, A group; two blood gas analysis,Group B pneumoperitoneum 10min PaCO2, PaO2 were significantly higher than those before anesthesia (P<0.05), A group of pneumoperitoneum 10min PaO2 was significantly higher than Group B, Group comparison there was a significant difference (P<0.05). Conclusion-inhalation anesthesia intubation anesthesia and combined spinal-epidural anesthesia can be used for gynecologic laparoscopic surgery, but the combined spinal-epidural anesthesia for surgery of laparoscopic surgery a short time, in the operation time>1.5h the surgery to the trachea better control of respiratory intubation.
【Key Words】 gynecology; laparoscopic surgery; Anesthesia
妇科腹腔镜手术具有创伤小,恢复快等优点,近几年来,临床已广泛应用,但由于手术时间长短不一,短时间手术1h内即可完成,长则3h-4h,尤其是妇科腹腔镜手术的特殊体位对呼吸、循环均有很大的影响,这无疑给麻醉提出了更高的要求,腹腔镜手术因气腹、患者体位、高碳酸血症,心律失常,迷走神经张力增高等对患者循环造成一定的影响[1],其麻醉方式的选择亦逐渐引起人们的重视 ......
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