2种麻醉方式对小儿腹腔镜手术应激反应的干预

唐文; 王珊; 叶茂; 徐颖

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2种麻醉方式对小儿腹腔镜手术应激反应的干预

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- 2种麻醉方式对小儿腹腔镜手术应激反应的干预
- Two approaches to pediatric anesthesia during laparoscopic operation: evaluation on stress response
- 陆军军医大学学报 2009年31卷第4期页码：365-367
- 作者机构：
- 作者简介：
- 基金信息：
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  中图分类号： R614;R725.72
- 纸质出版：2009
- 稿件说明：
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唐文,王珊,叶茂,徐颖.2种麻醉方式对小儿腹腔镜手术应激反应的干预[J].陆军军医大学学报(原第三军医大学学报),2009,31(04):365-367.

　TANG Wen,WANG Shan,YE Mao,XU Ying.Two approaches to pediatric anesthesia during laparoscopic operation: evaluation on stress response[J].J Amry Med Univ (J Third Mil Med Univ),2009,31(04):365-367.
唐文,王珊,叶茂,徐颖.2种麻醉方式对小儿腹腔镜手术应激反应的干预[J].陆军军医大学学报(原第三军医大学学报),2009,31(04):365-367. DOI：

　TANG Wen,WANG Shan,YE Mao,XU Ying.Two approaches to pediatric anesthesia during laparoscopic operation: evaluation on stress response[J].J Amry Med Univ (J Third Mil Med Univ),2009,31(04):365-367. DOI：

摘要

目的探讨有效调控腹腔镜手术患儿围手术期应激反应的麻醉方式。方法 1～3岁ASAⅠ-Ⅱ腹腔镜手术患儿40例，按随机数字表法分为全麻组（GA组）和全麻复合硬膜外阻滞组（GEA组），各20例。术中监测HR、MAP、SpO

、P

、并于麻醉前5 min(T

)、气腹前5 min (T

)、气腹开始后5 min(T

)、气腹开始后30 min(T

)、气腹结束后30 min(T

)及气腹结束后24 h(T

)，抽血测肾上腺素（E）、去甲肾上腺素（NE）、IL-6及IL-10浓度。结果 ①与T

比较全麻组HR、MAP在T

、T

时显著升高；GEA组内比较差异无统计学意义（P0.05），2组间比较差异有统计学意义（t=4.749

t=10.349

t=13.632

t=10.051

P0.01）。②E、NE均随手术进行逐渐升高，T

时E仍高于T

时，GEA组NE T

时已明显下降。GEA组在T

、T

各时点E和NE含量均明显低于GA组，差异有统计学意义（P0.05）。③2组IL-6水平与T

时比较，T

、T

时升高，T

时开始下降，差异有统计学意义（P0.05），组间比较差异无统计学意义（P0.05）。2组IL-10随手术时间升高与T0相比差异有统计学意义（P0.05），且GEA组较GA组T

～T

时增高有统计学意义（P0.05）。结论小儿腹腔镜手术可致明显的应激反应，全麻复合硬膜外阻滞麻醉方式较全麻具有改善血流动力学、患儿苏醒快且有效抑制应激反应程度的优势。

Abstract

Objective To find a more suitable approach to pediatric anesthesia during laparoscopic operation to alleviate str

ess response. Methods Forty patients

1 to 3 years of age

ASA grade Ⅰ-Ⅱ

underwent general anesthesia (group GA) and combined general epidural anesthesia (group GEA) during their laparoscopic operation. Heart rate (HR)

mean arterial pressure (MAP)

ECG

SPO

PETCO

blood gas

plasma epinephrine

plasma norepinephrine

plasma IL-6 and IL-10 were monitered and recorded five minutes before anesthesia (T

)

pre-pneumoperitoneum (T

)

5 min after pneumoperitoneum (T

)

30 min after pneumoperitoneum (T

)

30 min after operation (T

) and 24 h after operation (T

). Results (1) HR

MAP of group GA were increased obviously at T

compared to T

(P0.05)

but of no significant change in group GEA (P0.05). Significant difference was found at T

and T

between group GA and group GEA (t=4.749

10.349

13.632

10.051

P0.01). (2) In both groups

the concentration of plasma epinephrine and norepinephrine were increased gradually. Plasma epinephrine and plasma norepinephrine of group GA were higher than those of group GEA (P0.05). (3) Plasma IL-6 at T

got higher than that at T

in both groups (P0.05)

then decreased at T

but it showed no significant change between two groups at each time point (P0.05). Plasma IL-10 at T

were higher than that at T

in both groups (P0.05). Plasma IL-10 of group GEA at T

-T

was higher than that of group GA (P0.05). Conclusion Serious stress response may occur during pediatric laparoscopic surgery. Compared to single general anesthesia

general anesthesia combined with epidural block maintains more stable hemodynamics

exerts more effective postoperative analgesia

shortens postoperative recovery and reduces surgical stress response.

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