两种麻醉对子宫切除术血管应激反应的比较

Comparision of Two Kinds of Anesthesia on Cardiovascular Stress in Patients Undergoing Metrosteresis

目的比较腰硬联合麻醉与硬膜外麻醉对子宫切除术患者血液动力学和应激反应的影响。方法 180例行子宫切除术患者随机分为对照组和观察组,分别采用硬膜外麻醉和腰硬联合麻醉。两组分别于麻醉前(T0)、气管插管(T1)、切皮(T2)、切除子宫(T3)和拔除气管导管(T4)时常规检测无创血压(SBP和DBP)、心率(HR)、脉搏血氧饱和度(SpO2)以及检测血清白介素-6(IL-6)、皮质醇和血糖水平的变化。结果两组患者T1、T2、T3和T4时两组SBP、DBP、HR和SpO2与T0比较差异均具有统计学意义(P<0.01),并且组间比较差异有统计学意义(P<0.01);两组患者T1、T2、T3和T4时IL-6、皮质醇和血糖水平与T0比较差异均具有统计学意义(P<0.01),并且组间比较差异也具有统计学意义(P<0.01)。结论腰硬联合麻醉对子宫切除术患者血流动力学影响较小,可减轻患者的血管应激反应。

Objective To compare the effect of spinal combined epidural anesthesia and epidural anesthesia on hemodynamics and cardiovascular stress in patients with metrosteresis. Methods One hundred and eighty patients with metrosteresis were randomly divided into control group and observation group. The patients in control group and observation group underwent epidural anesthesia and spinal combined epidural anesthesia respecturely. Invasive blood （SBP and DBP）, heart rate （HR）, oxyhemoglobin saturation （SpO2）, the serum levels of interleukin-6 （IL-6）, cortisol and blood sugar were measured inroutin practive before anesthesia （To）, at the points of tracheal cannula （T1）, operation of skin cut （T2）, resection of uterus （T3） and withdrawing tube （T4）. Results SBP, DBP, HR and Sp02 in both groups at TI, Tz, T3 and T4 were significantly different from those at TO （ P 〈 0.01 ） and there were significant differences between both groups （ P 〈 0.01 ） The serum levels of IL-6, cortisol and blood sugar in both groups at T1, T2, T3 and T4 were significantly different from those at TO （ P 〈 0.01 ）, and there were significant differences in both groups （ P 〈 0.01 ）. Conclusion Spinal combined epidural anesthesia affects the haemodynamics much less in patients with epidural anesthesia, and can produce less vascular stress compared with enidural anesthesia.