不同麻醉方式对下腹部开腹手术患者的麻醉效果

Effects of different anesthesia modes on patients undergoing laparotomy

目的探讨不同麻醉方式对下腹部开腹手术患者的麻醉效果。方法连续入选2017年4月至2018年1月新疆维吾尔自治区人民医院行择期开腹阑尾切除术患者120例,应用随机数字表法分为全身麻醉复合腹横肌平面阻滞组(GT组)、全身麻醉复合硬膜外阻滞组(GE组)和单纯全身麻醉组(G组),各40例。GT组和GE组不用肌肉松弛药物,G组应用顺式阿曲库铵维持肌肉松弛。比较手术医师对3组患者术中和闭合腹膜时肌肉松弛满意度的评分以及患者停药至拔管时间、拔管后清醒时间、对麻醉满意度评分和不良反应。结果 GT组3例、GE组2例因阻滞效果较差剔出本研究。手术医师对3组患者术中和闭合腹膜时肌肉松弛满意度的评分比较差异均无统计学意义(均P>0.05)。GT组和GE组停药至拔管时间、拔管后清醒时间均短于G组[(3. 7±1. 2)、(3. 6±1. 2) min比(7. 6±1. 9) min,(9. 7±2. 1)、(10.2±2.1)min比(20.6±3.8)min](均P<0.05),GT组与GE组比较差异均无统计学意义(均P>0. 05)。GT组患者对麻醉满意度评分高于GE组和G组[(4.5±0. 7)分比(3.1±0. 7)、(3.3±0. 7)分](均P<0.05),GE组和G组比较差异无统计学意义(P>0.05)。3组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论全身麻醉复合腹横肌平面阻滞与全身麻醉复合硬膜外阻滞对下腹部手术患者肌肉松弛作用基本一致,且全身麻醉复合腹横肌平面阻滞患者的麻醉整体满意度更高。

Objective To investigate the effects of different anesthesia modes on patients undergoing laparotomy. Methods A total of 120 patients undergoing elective open appendectomy in People′s Hospital of Xinjiang Uygur Autonomous Region from April 2017 to January 2018 were successively enrolled. They were randomly divided into 3 groups（n=40）; group GT had general anesthesia with transversus abdominis plane（TAP） block; group GE had general anesthesia with epidural block; group G had general anesthesia. Group GT and group GE did not use muscle relaxants; group G used cisatracurium. Surgeons′ muscle relaxation satisfaction score, extubation time, waking time, patients′ anesthesia satisfaction score and adverse reactions were analyzed. Results Three cases in group GT and 2 cases in group GE were excluded due to poor anesthesia response. There was no significant difference of surgeons′ muscle relaxation satisfaction scores during the operation and closure of peritoneum among all groups（P〉0.05）. Extubating time and waking time in group GT and GE were significantly shorter than those in group G[（3.7±1.2）,（3.6±1.2）min vs （7.6±1.9）min; （9.7±2.1）,（10.2±2.1）min vs （20.6±3.8）min]（P〈0.05）; there was no difference between group GT and group GE（P〉0.05）. Patients′ anesthesia satisfaction score in group GT was significantly higher than that in group GE and G[（4.5±0.7） vs （3.1±0.7）,（3.3±0.7）]（P〈0.05）; there was no difference between group GE and group G（P〉0.05）. There was no significant difference of the incidence of adverse reactions among the three groups（P〉0.05）. Conclusion General anesthesia with TAP block or epidural block have similar muscle relaxation effect on patients undergoing laparotomy; patients with TAP block show high satisfaction.