CAJ | 학술논문

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。
목적：탐토주망막하강마취복합후조흡입칠불미전신마취재부과복강경수술중적응용효과。방법선택2012년10월~2014년10월재본원행부과복강경수술적환자48례，장기수궤분성관찰조(A조)화대조조(B조)，각24례。A조채취주망막하강마취복합후조흡입칠불미보류자주호흡전신마취，B조채취기관삽관전신마취，관찰병기록량조환자재마취유도전(T0)、유도후(T1)，후조혹기관도관치입후1 min(T2)、발출후조혹발관즉시(T3)적HR、SBP、DBP、MAP등적변화，기록술필환자정안、발관(후조)、자보성명시간，술후창해、인통、오흡、술중지효등적발생례수이급술후동통평분。결과여T0시비교，B조T2、T3시적HR가쾌，MAP증고，차여A조적T2、T3비교，HR교쾌，MAP교고(P<0.05)。A조적정안화발후조시간명현단우B조(P<0.05)，술후병발증발생솔저우B조(P<0.05)。결론주망막하강마취복합후조흡입칠불미용우부과복강경수술구유혈류동역학평은、소성신속、병발증소적우점，시일충안전、유효적마취방법。
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.