蛛网膜下腔联合硬膜外阻滞麻醉对子宫肌瘤切除术患者的临床应用观察

Efficacy of subarachnoid anesthesia combined with epidural block in patients undergoing hysteromyomectomy

目的探讨蛛网膜下腔联合硬膜外阻滞麻醉对子宫肌瘤切除术患者麻醉效果、苏醒质量及免疫功能的影响。方法选取2018年10月至2020年10月间宝鸡市中医医院收治的96例均行子宫肌瘤切除术的子宫肌瘤患者,采用随机数字表法分为A、B、C三组,每组32例。A组患者采用硬膜外阻滞麻醉,B组患者采用蛛网膜下腔阻滞麻醉,C组患者采用蛛网膜下腔联合硬膜外阻滞麻醉,比较三组患者的麻醉效果、术后不同时间视觉模拟量表(VAS)评分、不良反应及手术前后免疫功能。结果 A组患者麻醉优良率为78.1%,B组患者为87.5%,C组患者为100.0%,C组高于B组和A组,差异有统计学意义(P <0.05)。术后2h,三组患者VAS评分比较,差异无统计学意义(P>0.05)。术后6h、12h和24h,C组患者VAS评分均低于B组和A组,差异均有统计学意义(均P <0.05)。A组患者不良反应发生率为34.4%,B组为28.1%,C组为6.3%,C组低于B组和A组,差异均有统计学意义(均P <0.05)。术后,C组患者CD4^(+)、CD3^(+)和CD4^(+)/CD8^(+)水平均高于B组和A组,差异均有统计学意义(均P <0.05)。结论蛛网膜下腔联合硬膜外阻滞麻醉对子宫肌瘤切除术患者的麻醉效果更好,术后疼痛反应较低,不良反应减少,提升苏醒质量和免疫功能,值得临床推广。

Objective To investigate the efficacy of subarachnoid anesthesia combined with epidural block in patients undergoing hysteromyomectomy and the effects on quality of recovery and function of immune system. Methods Ninety-six patients undergoing hysteromyoma were selected at Baoji Hospital of Traditional Chinese Medicine from October 2018 to October 2020. They were randomly divided into three groups,say,group A,group B and group C with 32 patients in each group. Group A received epidural nerve block,group B received subarachnoid anesthesia and group C received subarachnoid anesthesia combined with epidural nerve block. Anesthesia efficacy,visual analogue scale( VAS) score at different time points after operation,adverse reactions and function of immune system before and after operation were compared among the three groups. Results The excellent and good rate of was 78. 1%,87. 5% and 100. 0%,respectively in group A,group B and group C( P < 0. 05). There was no significant difference in the VAS scores among the three groups at 2 h after the operation( P > 0. 05). But at 6 h,12 h and 24 h after the operation,VAS score was lower in group C than in group B and group A( all P < 0. 05). The incidence of adverse reactions was 34. 4%,28. 1% and 6. 3%,respectively in group A,group B and group C( all P <0. 05). After the operation,the levels of CD4^(+),CD3^(+)and CD4^(+)/CD8^(+)were higher in group C than in group B and group A( all P < 0. 05). Conclusion Subarachnoid anesthesia combined with epidural block shows good efficacy in patients undergoing hysteromyomectomy,and the incidence of postoperative pain reaction is low. Moreover,it can reduce the adverse reactions,promote the recovery quality and function of immune system,and it is worthy of clinical application and promotion.