不同麻醉方法用于腹腔镜子宫切除术患者的效果

Efficacy of different methods of anesthesia for laparoscopic hysterectomy

目的评价不同麻醉方法用于腹腔镜子宫切除术患者的效果。方法择期拟行腹腔镜子宫切除术患者60例，ASA分级I或Ⅱ级，年龄45～60岁，体重55—65kg，采用随机数字表法，将患者随机分为静吸复合全麻组（I组）和脊椎-硬膜外麻醉＋全麻组（Ⅱ组），每组30例。I组麻醉诱导后，吸入七氟醚，持续输注瑞芬太尼维持麻醉；Ⅱ组先采取脊椎．硬膜外麻醉，麻醉平面稳定后全麻诱导，吸入七氟醚维持麻醉，维持状态熵45～60。于入室后、气腹完成、气腹后10min、术中持续牵拉子宫、拔除喉罩和拔除喉罩后10min（L0-5）时采集桡动脉血样，测定血浆肾上腺素（AE）、去甲肾上腺素（NE）和多巴胺（DA）浓度，术毕记录患者自主呼吸恢复时间、拔除气管导管时间和清醒时间，观察术后48h内不良反应及追加镇痛药物情况，术后48h时行患者满意度评分。结果与I组比较，Ⅱ组患者T3-5，时血浆AE和NE浓度、T3-5时血浆DA浓度降低，自主呼吸恢复时间、拔除气管导管时间和清醒时间明显缩短，术后躁动和追加镇痛药物发生率明显降低（P〈0．05），术中知晓、术后恶心呕吐发生率和术后48h时患者满意度评分差异无统计学意义（P〉0．05）。结论脊椎．硬膜外麻醉十全麻用于腹腔镜子宫切除术患者时的效果优于静吸复合全麻。

Objective To investigate the efficacy of different methods of anesthesia for laparoscopic hysterectomy. Methods Sixty ASA I or II patients, aged 45-60 yr, weighing 55-65 kg, scheduled for laparoscopic hysterectomy, were equally and randomly divided into 2 groups： combined intravenous-inhalational anesthesia group （group I ） and combined spinal-epidural anesthesia （CSEA） ＋ general anesthesia group （group II ）. In group I , anesthesia was maintained with inhalation of sevoflurane and infusion of remifentanil after induction of anesthesia. In group II , CSEA was performed, after the upper level of sensory block was stable, general anesthe- sia was induced and maintained with inhalation of sevoflurane, and state entropy （SE） was maintained at 45-60. Arterial blood samples were taken to determine the plasma concentrations of adrenaline （AE）, norepinephrine （NE） and dopamine （DA） after admission to the operation room, after completion of pneumoperitoneum, at 10 rain after pneumoperitoneum, during uterus traction, during removal of the laryngeal mask airway, and at 10 min after removal of the laryngeal mask airway （T0-4）. The time for recovery of spontaneous breathing, extubation time, and time of regaining consciousness were recorded at the end of operation. The side-effects and number of patients requiring increments of analgesics were also recorded within 48 h after operation. Patient＇ s satisfaction was recorded at 48 h after operation. Results Compared with group I , the plasma concentrations of AE and NE at T3-4 and the plasma concentrations of DA at T3-5 were significantly decreased, the time for recovery of spontaneous breathing, extubation time, and time of regaining consciousness were significantly shortened, and the incidence of agita tion and the number of patients requiring increments of analgesics were significantly decreased in group II （ P 〈 0.05）. There was no significant difference in the incidence of intraoperative awareness, and nausea and vomiting after operation, and the level of patient＇ s satisfaction at 48 h after operation between the two groups （ P 〉 0.05）. Conclusion CSEA ＋ general anesthesia has better efficacy than combined intravenous-inhalational anesthesia when used for laparoscopic hysterectomy.