腰硬联合麻醉和硬膜外麻醉对子宫全切术麻醉效果及对血清胃动素和胃泌素的变化影响

Efficacy of combined spinal and epidural anesthesia vs epidural anesthesia alone in total hysterectomy: Impact on serum motilin and gastrin

目的探讨腰硬联合麻醉和硬膜外麻醉对子宫全切术麻醉效果及对血清胃动素和胃泌素的变化影响。方法选取2016-09/2017-01浙江省肿瘤医院行子宫全切术患者92例作为研究对象,根据随机数表法随机分为联合麻醉组和硬膜外麻醉组,各46例,分别行腰硬联合麻醉和硬膜外麻醉,对术中一般指标进行比较,观察两组患者血清胃动素和胃泌素的变化情况,并对患者心率、平均动脉压、苏醒时间和术中并发症进行比较.结果联合麻醉组患者麻醉起效时间更短,且麻醉用药量更少,差异有统计学意义(P<0.05);两组患者手术持续时间无明显差异(P>0.05);两组麻醉前血清胃动素水平无明显差异(P>0.05),麻醉后,联合麻醉组下降幅度更加明显,术中子宫切除时血清胃动素水平均呈现一过性升高,术后1 d均显著降低,且联合麻醉组下降程度更加明显,差异有统计学意义(P<0.05);两组子宫全切术患者血清胃泌素在麻醉前、麻醉后、子宫切除时、术后1 d后并无明显变化,且两组水平无明显差异,差异无统计学意义(P>0.05);患者麻醉后,联合麻醉组在心率、平均动脉压、苏醒时间等指标方面优于硬膜外麻醉组,差异有统计学意义(P<0.05);联合麻醉组患者并发症发生率(6.52%)明显低于硬膜外麻醉组(19.57%),有明显统计学差异(P<0.05)。结论对子宫全切术采用腰硬联合麻醉方式更加简单安全有效,且并发症较少,另外,血清胃动素和胃动素在两种麻醉方式术中均存在不稳定现象,进一步降低围术期手术的应激反应对血清胃动素、胃泌素的变化有积极的临床意义,值得临床进一步推广。

AIM To compare the efficacy of combined spinal and epidural anesthesia vs epidural anesthesia in total hysterectomy and the impact on the serum motilin and gastrin.METHODS Ninety-two patients who underwent total hysterectomy at Zhejiang Cancer Hospital from September 2015 to January 2016 were selected and randomly divided into two groups to receiver either combined spinal and epidural anesthesia or epidural anesthesia alone,with 46 cases in each groups.The two groups of patients were compared for intraoperative parameters,serum motilin and gastrin,patients'heart rate,mean arterial pressure,and awakening time,and intraoperative complications.RESULTS Time to successful induction of anesthesia was significantly shorter and use of anesthetics was significantly less in the combination group than in the epidural anesthesia alone group(P<0.05).There was no significant difference in operative time between the two groups(P>0.05).Before anesthesia,serum motilin showed no significant difference between the two groups(P>0.05);after anesthesia,the combination group had a more obvious decrease(P<0.05).Serum motilin exhibited a transient increase intraoperatively,but declined at day 1 postoperatively in both groups;the decrease was more significant in the combination group(P<0.05).Serum gastrin showed no obvious change throughout the process in both groups,and there was no statistically significant difference between the two groups at all time points(P>0.05).After anesthesia,the combination group was superior to the epidural anesthesia alone group with regard to heart rate,mean arterial pressure,and awaking time,and the difference was statistically significant(P<0.05).The incidence of complications(6.52%)was significantly lower in the combination group than in the epidural anesthesia alone group(19.57%,P<0.05).CONCLUSION Combined spinal and epidural anesthesia for total hysterectomy is safer and more effective and has fewer complications than epidural anesthesia alone.However,serum motilin and gastrin levels are unstable in both groups,and reducing perioperative surgical stress will have a positive impact on serum motilin and gastrin levels.