基于应激反应及血流动力学变化观察不同麻醉方法在妇科腹腔镜手术中的应用

Observation on application of different anesthesia methods in gynecological laparoscopic surgery based on stress reaction and hemodynamic change

目的通过观察应激反应及血流动力学变化,探讨不同麻醉方法在妇科腹腔镜手术中的应用。方法选择2010年7月至2015年9月82例行妇科腹腔镜手术患者,随机分为硬膜外麻醉(A1)组及全身麻醉(A2)组,每组各41例,分别于麻醉前(T0)、气腹后10min(T1)、气腹后30min(T2)、停气腹后10min(T3)不同时间点观察各组患者心率(HR)、收缩压(SBP)、舒张压(DBP)、血糖(Glu)、皮质醇、去甲肾上腺素(NE)、血氧饱和度(SpO_2)水平变化。结果 T1、T2时点A2组HR明显高于A1组,差异有统计学意义(P<0.05);T1、T2、T3时点A2组DBP、SBP明显高于A1组,差异有统计学意义(P<0.05);A1组皮质醇、NE水平升高速度比A2组快,A2组麻醉后血糖各时点低于麻醉前,T2、T3时点A2组血糖水平明显低于A1组,差异有统计学意义(P<0.05);A1组SpO_2较麻醉前显著降低,低于同时点A2组,差异有统计学意义(P<0.05)。结论妇科腹腔镜手术中可采取硬膜外麻醉及气管插管全身麻醉,加强监测患者血流动力学指标;全身麻醉在抑制激素、维持血气状态方面优于硬膜外麻醉。

Objective To explore the application of different anesthesia methods in gynecological laparoscopic surgery by observing the stress reaction and hemodynamic change.Methods A total of 82 patients with gynecological laparoscopic surgery in our hospital from July 2010 to September 2015 were selected and randomly divided into the epidural anesthesia group（A1）and general anesthesia group（A2）,41 cases in each group.The changes of heart rate（HR）,systolic blood pressure（SBP）,diastolic blood pressure（DBP）,blood glucose（Glu）,cortisol,norepinephrine（NE）and oxygen saturation levels in each group were observed before anesthesia（T0）,at 10 min after pneumoperitoneum（T1）,30 min after pneumoperitoneum（T2）and 10 min after stopping pneumoperitoneum（T3）.Results HR at T1,T2 in the group A2 was significantly higher than that in the group A1,the difference was statistically significant（P〈0.05）,DBP and SBP at T1,T2,T3 in the group A2 were significantly higher than those in the group A1,the difference was statistically significant（P〈0.05）;the increase speed of cortisol and NE levels in the group A1 was higher than that in the group A2（P〈0.05）,the blood Glu level at each time point after anesthesia in the group A2 was lower than that before anesthesia,the Glu level at T2,T3 in the group A2 was significantly lower than that in the group A1,the difference was statistically significant（P〈0.05）.Compared with before anesthesia,SpO2 after anesthesia in the group A1 was decreased significantly,which was lower than that at the same time point in the group A2,the difference was statistically significant（P〈0.05）.Conclusion Epidural anesthesia and general anesthesia may be used in gynecological laparoscopic surgery,monitoring the hemodynamic indicators is strengthened.General anesthesia is superior to epidural anesthesia in the aspects of inhibiting hormone,maintaining blood gas status.