硬膜外麻醉对妇科腹腔镜手术患者血糖及血液动力学影响作用分析

EFFECTS OF EPIDURAL ANESTHESIA ON BLOOD GLUCOSE AND HEMODYNAMICS IN PATIENTS WITH GYNECOLOGIC LAPAROSCOPIC SURGERY

目的探讨硬膜外麻醉对妇科腹腔镜手术患者血糖及血液动力学影响作用。方法将我院2012年1月~2014年1月期间收治的需要进行腹腔镜手术的妇科患者108例随机平均分为观察组54例和对照组54例,观察组患者采用硬膜外麻醉进行手术,对照组患者采用全身麻醉进行手术,对比观察两组患者麻醉前、气腹后、术后的血流动力情况以及血糖情况,并记录两组患者的手术时间、术中失血量、补液量以及气腹时间。结果两组患者的手术时间、气腹时间、术中出血量及补液量无明显差异（p〉0.05）;而观察组患者在气腹5 min时心率明显高于对照组;在气腹30 min及术毕时的血压显著低于麻醉前;且观察组患者气腹后及术后的收缩压及舒张压均显著低于对照组患者（p〈0.05）;而对照组患者气腹后的血压均显著高于麻醉前,术毕时患者的舒张压仍高于麻醉前（p〈0.05）,对照组患者术毕时血糖显著高于麻醉前水平（p〈0.05）。结论硬膜外麻醉在合适的阻滞平面下具有更理想地降低应激反应、控制血压、维持血糖的效果。

Objective To investigate the effects of epidural anesthesia on blood glucose and hemodynamics in patients undergoing gynecological laparoscopic surgery. Methods 108 cases undergoing laparoscopic gynecology surgery in our hospital from January 2012 to January 2014 were randomized into the observation group and control group equally. The observation group was treated by epidural anesthesia for surgery, while the control group was trea- ted by general anesthesia. The hemodynamics and blood glucose in the two groups were compared before anesthesia, after pneumoperitoneum and surgery. The operative time, blood loss during operation, volume of fluid infusion and pneumoperitoneum time were recorded. Results The operative time, blood loss during operation, volume of fluid in- fusion and pneumoperitoneum time had no significant differences between the two groups （p 〉 0.05）. The heart rate in the observation group was significantly higher than that in the control group at the time point of 5 min after pneumo- peritoneum. The blood pressure in the observation group was significantly lower than that before anesthesia at the time of 30 min after pneumoperitoneum, as well asafter operation. Theblood pressure after pneumoperitoneum in the control group was significantly higher than that before anesthesia, with DBP after operation higher than that before anesthesia （p 〈 0.05 ）. Postoperative blood glucose in the control group was significantly higher than that before anesthesia （p 〈 0.05 ）. Both systolic blood pressure and diastolic blood pressure in the observation group after pneumoperitoneum and operationwere significantly lower than thosein the control group （p 〈 0.05 ）. Conclusion Epidural anesthesia is more ideal to reduce stressresponse, control blood pressure, and maintainnormal blood sugar levels.