复合麻醉对腹腔镜辅助阴式子宫全切术患者应激反应及并发症的影响

The impact of combined anesthesia on stress reaction and complications of patients with laparoscopic assisted vaginal hysterectomy

目的：观察硬膜外联合全麻减少腹腔镜辅助阴式子宫全切术患者的应激反应及并发症的效果。方法：200例行腹腔镜辅助阴式子宫全切术患者随机分成硬膜外复合全麻手术组（观察组）与全麻组（对照组）各100例,观察两组手术过程中麻醉前（T0）,CO2气腹前5 min（T1）,CO2气腹[压力达13～16 mm Hg（1 mm Hg=0.133 k Pa）]后10 min（T2）,40 min（T3）及术毕10 min（T4）患者血浆皮质醇（Cor）、去甲肾上腺素（NE）、肾上腺素（E）、血糖（Glu）和促肾上腺皮质激素（ACTH）水平的变化及术后恶心呕吐、头晕、嗜睡、瘙痒等并发症发生率的差异。结果：两组患者T0,T1,T2,T3,T4各时点Cor,NE,E,Glu,ACHT浓度的检测结果显示,除T0点Cor,NE,E,Glu,ACHT与T1点Glu差异无统计学意义外（P〉0.05）,其他各点Cor,NE,E,Glu,ACHT比较,差异均有统计学意义（P〈0.05）。两组患者麻醉后恶心呕吐、头晕、嗜睡、瘙痒的发生,观察组明显比对照组少（P〈0.05）。结论：在腹腔镜辅助阴式子宫全切术中,采用全麻复合硬膜外麻醉能有效降低手术过程的应激反应,减少术后并发症的发生。

Objective： To investigate the effect of Epidural combined general anesthesia to reduce stress and complications of patients with laparoscopic assisted vaginal hysterectomy. Methods： Two hundreds patients with laparoscopic assisted vaginal hysterectomy were randomly divided into epidural and general anesthesia group（ observation group） and general anesthesia group（ control group）,100 cases in each group. The difference of plasma cortisol（ Cor）,norepinephrine（ NE）,epinephrine（ E）,glucose（ Glu） and adrenocorticotropic hormone（ ACTH） and postoperative nausea and vomiting,dizziness,drowsiness,itching and other complications incidence were observed in patients of the two groups during surgery before anesthesia（ T0）,CO2 insufflation 5 min（ T1）,CO2pneumoperitoneum（ pressure of 13 ～ 16 mm Hg）（ 1 mm Hg = 0. 133 k Pa） after 10 min（ T2）,40 min（ T3）,and after surgery 10 min（ T4）. Results： Test results of Cor,NE,E,Glu,ACHT concentrations in the two groups at T0,T1,T2,T3,T4 time point showed that in addition to T0 point Cor,NE,E,Glu,ACHT and T1 point Glu were no difference（ P〉0. 05）,Cor,NE,E,Glu,ACHT at the other points were statistically different（ P〈0. 05）. Nausea and vomiting,dizziness,drowsiness,itching occurred in the observation group was significantly less than the control group in postoperative（ P〈0. 05）. Conclusion： General anesthesia combined with epidural anesthesia in Laparoscopic assisted vaginal hysterectomy can effectively reduce the stress response and the incidence of postoperative complications during surgery.