不同麻醉方式在肥胖患者腹腔镜子宫全切术中的效果比较

Comparison of Laparoscopic Hysterectomy Under Different Anesthesia in Obese Patients

目的比较不同麻醉方式在肥胖患者腹腔镜子宫全切术中的效果。方法选取2018年9月至2019年9月于郑州大学第一附属医院行腹腔镜子宫全切术的120例肥胖患者。采用随机数表法将患者分为全麻组(G组)和全麻复合硬膜外阻滞组(QG组),各60例。在腹腔镜子宫全切术中,对G组患者进行全身麻醉,对QG组患者进行全麻复合硬膜外阻滞。比较两组入室后(T0)、麻醉诱导时(T1)、气腹建立后10 min(T2)、关闭气腹后(T3)及拔管后(T 4)的心率(HR)、平均动脉压(MAP)、呼气末二氧化碳(PETCO2)及气道压(Paw)。比较两组术后4 h认知功能评分以及苏醒时、术后4h、术后24 h警觉与镇静评分。比较两组术后镇痛泵按压次数、麻醉满意度、术后恶心呕吐发生率。结果T0、T1时刻,QG组与G组的HR、MAP比较,差异无统计学意义(均P>0.05)。T2、T3、T4时刻,QG组HR和MAP均低于G组(均P<0.05)。T1时刻,QG组Paw与G组比较,差异无统计学意义(P>0.05)。T2、T3时刻,QG组Paw低于G组(均P<0.05)。两组术中P ETCO2比较,差异无统计学意义(P>0.05)。QG组术后4 h认知功能评分高于G组(P<0.05)。QG组苏醒时和术后4 h警觉与镇静评分均高于G组(均P<0.05)。与G组相比,QG组术后镇痛泵按压次数较少,麻醉满意度较高(均P<0.05)。术后2、12、24 h,QG组恶心呕吐发生率均低于G组(均P<0.05)。结论在肥胖患者腹腔镜子宫全切术中使用全麻复合硬膜外阻滞,有助于维持血流动力学的稳定,改善患者术后的认知功能,减轻疼痛,减少不良反应。

Objective To compare the effects of different anesthesia methods in laparoscopic hysterectomy for obese patients.Methods A total of 120 obese patients underwent laparoscopic hysterectomy in the First Affiliated Hospital of Zhengzhou University from September 2018 to September 2019 were selected.Using random number table method,the patients were divided into general anesthesia group(group G)and general anesthesia combined epidural block group(group QG),60 cases in each group.In laparoscopic hysterectomy,patients in group G were given general anesthesia,and patients in group QG were given general anesthesia combined with epidural block.The heart rate(HR),mean arterial pressure(MAP),end-breathing carbon dioxide(PETCO2)and airway pressure(Paw)were compared between the two groups after admission(T0),induction of anesthesia(T1),10 minutes after pneumoperitoneal establishment(T2),after pneumoperitoneal closure(T3)and after extubation(T4).The score of cognitive function at 4 hours after operation,the scores of alertness and sedation at wake,4 hours and 24 hours after operation were compared between the two groups.Postoperative analgesic pump compressions,satisfaction with anesthesia and incidence of postoperative nausea and vomiting were compared between the two groups.Results At T0 and T1,there were no statistical differences on HR and MAP between group QG and group G(all P>0.05).Compared with group G,MAP and HR in group QG were lower at T2,T3 and T4(all P<0.05).At T1,there was no statistical difference on Paw between group QG and group G(P>0.05).At T 2 and T3,Paw in group QG was lower than that in group G(both P<0.05).There was no statistical difference on intraoperative P ET CO 2 between the two groups(P>0.05).The score of postoperative cognitive function at 4 hours after operation in group QG was higher than that in group G(P<0.05).The scores of alertness and sedation at wake and 4 hours after operation in group QG were higher than those in group G(both P<0.05).Compared with group G,the number of postoperative analgesia pump compressions was less and anesthesia satisfaction was higher in group QG(both P<0.05).At 2,12,and 24 hours after surgery,the incidence of nausea and vomiting in group QG was lower than that in group G(all P<0.05).Conclusion General anesthesia combined with epidural block in laparoscopic hysterectomy for obese patients is helpful to maintain the stability of hemodynamics,improve postoperative cognitive function,relieve pain and reduce adverse reactions.