蛛网膜下腔麻醉复合喉罩吸入七氟醚全身麻醉在妇科腹腔镜手术中的应用效果观察

摘要

目的：探讨蛛网膜下腔麻醉复合喉罩吸入七氟醚全身麻醉在妇科腹腔镜手术中的应用效果。方法选择2012年10月~2014年10月在本院行妇科腹腔镜手术的患者48例，将其随机分成观察组(A组)和对照组(B组)，各24例。A组采取蛛网膜下腔麻醉复合喉罩吸入七氟醚保留自主呼吸全身麻醉，B组采取气管插管全身麻醉，观察并记录两组患者在麻醉诱导前(T0)、诱导后(T1)，喉罩或气管导管置入后1 min(T2)、拔出喉罩或拔管即时(T3)的HR、SBP、DBP、MAP等的变化，记录术毕患者睁眼、拔管(喉罩)、自报姓名时间，术后呛咳、咽痛、误吸、术中知晓等的发生例数以及术后疼痛评分。结果与T0时比较，B组T2、T3时的HR加快，MAP增高，且与A组的T2、T3比较，HR较快，MAP较高(P<0.05)。A组的睁眼和拔喉罩时间明显短于B组(P<0.05)，术后并发症发生率低于B组(P<0.05)。结论蛛网膜下腔麻醉复合喉罩吸入七氟醚用于妇科腹腔镜手术具有血流动力学平稳、苏醒迅速、并发症少的优点，是一种安全、有效的麻醉方法。%Objective To explore the application effect of subarachnoid anesthesia combined withgeneral anesthesia of inhaling sevoflurane with laryngeal mask in gynecological laparoscopic operation. Methods 48 cases with laparoscopic operation treated in our hospital from October 2012 to October 2014 were selected and they were randomly divided into observation group (group A,n=24) and control group (group B,n=24).Group A was given subarachnoid anesthesia com-bined with general anesthesia (preserving spontaneous breathing) of inhaling sevoflurane with laryngeal mask,while group B was given tracheal intubation general anesthesia.The change of HR,SBP,DBP,MAP and so on before (T0) and after (T1) the induction of anesthesia,after laryngeal mask or endotracheal tube placement 1 min (T2),pulling out of la-ryngeal mask or extubation immediately (T3) was observed and recorded respectively.The time of eyes open and extuba-tion (pull out of laryngeal mask) and self-reported name after operation was recorded respectively,and number of cases of bucking,sore throat,aspiration,and intraoperative awareness after operation and postoperative pain score was recorded respectively. Results Compared with T0,HR and MAP was increased respectively at T2,T3 and compared with group A at T2,T3,HR was faster and MAP was higher (P<0.05).The time of eyes open and pulling out of laryngeal mask in group A was obviously shorter than that of group B (P<0.05).The incidence rate of postoperative complications was lower than that of group B (P<0.05). Conclusion Subarachnoid anesthesia combined with inhaling sevoflurane with laryngeal mask applied in gynecological laparoscopic operation has advantages of stable hemodynamics,rapid recovery,fewer complica-tions,and it is a safe and effective anesthesia method.