腹横肌平面复合全身麻醉在妇科日间子宫肌瘤剔除术患者镇痛效果及对血流动力学、应激反应及血管活性因子的影响

Transverse Abdominal Muscle Plane Combined with General Anesthesia in the Analgesic Effect and Influence on Hemodynamics,Stress Response and Vasoactive Factors in Patients Undergoing Gynecological Day Myomectomy

目的探析腹横肌平面复合全身麻醉在妇科日间子宫肌瘤剔除术患者镇痛效果及对血流动力学、应激反应及血管活性因子的影响。方法行便利抽样法从本院妇科于2019年1月至2021年1月收治行日间子宫肌瘤剔除术患者中选取64例实行研究,循随机化原则设置对照组及观察组,对照组于麻醉诱导后,手术实施前采取全身麻醉,观察组施行腹横肌平面复合全身麻醉,术后均行静脉自控镇痛(PCIA),比较两组镇痛效果、血流动力学指标、应激反应参数、血管活性因子水平及并发症情况。结果观察组术中丙泊酚、瑞芬太尼维持麻醉用量及术后PCIA镇痛次数均低于对照组(P<0.05);于T_(4)、T_(5)、T_(6)、T_(7)时点,两组VAS评分呈先升后降趋势,观察组于T_(4)、T_(5)、T_(6)、T_(7)时点VAS评分相比于对照组均更低(P<0.05);于T_(0)、T_(1)、T_(2)、T_(3)时点,两组MAP、HR水平呈先升后降趋势,观察组于T_(1)、T_(2)及T_(3)时点MAP、HR较对照组均更低(P<0.05);于T_(1)、T_(3)及T_(7)时点,两组Cor、NE水平呈先升后降趋势,观察组Cor、NE水平均低于对照组;于T_(1)、T_(7)时点,两组VEGF-C、PGE2水平均有下降,观察组VEGF-C水平低于对照组(P<0.05),但两组PGE2水平比较,差异无统计学意义(P>0.05);两组并发症总发生率比较,差异无统计学意义(P>0.05)。结论行日间子宫肌瘤剔除术患者运用腹横肌平面复合全身麻醉,可发挥良好镇痛效果,血流动力学及应激反应影响较小,且可抑制血管活性因子水平。

Objective To explore the analgesic effect of transversus abdominis plane combined with general anesthesia in gynecological day myomectomy patients and its influence on hemodynamics,stress response and vasoactive factors.Methods The convenience sampling method was used to select 64 patients from the gynecology department of our hospital who underwent day uterine myomectomy from January 2019 to January 2021.The control group and the observation group were set up according to the principle of randomization.After induction of anesthesia,general anesthesia was taken before the operation,the observation group was given general anesthesia at the transverse abdominis plane,and PCIA was performed after the operation.The analgesic effect,hemodynamic indexes,and stress response of the two groups were compared.Parameters,levels of vasoactive factors and complications.Results The maintenance anesthesia dosage of propofol and remifentanil in the observation group and the number of PCIA analgesia after surgery were lower than those in the control group(P<0.05);at T_(4),T_(5),T_(6),and T_(7),the VAS scores of the two groups were The VAS scores of the observation group at T_(4),T_(5),T_(6),and T_(7) were lower than those of the control group(P<0.05);at T_(0),T_(1),T_(2),and T_(3),the two groups of MAP,HR The level first increased and then decreased.The MAP and HR of the observation group were lower than those of the control group at T_(1),T_(2),and T_(3)(P<0.05);at T_(1),T_(3),and T_(7),the levels of Cor and NE in the two groups were first After rising and falling,the levels of Cor and NE in the observation group were lower than those in the control group;at T_(1) and T_(7),the levels of VEGF-C and PGE2 in the two groups both decreased,and the VEGF-C levels in the observation group were lower than those of the control group(P<0.05),but the difference in PGE2 levels between the two groups was not statistically significant(P>0.05);the total incidence of complications between the two groups was not statistically significant(P>0.05).Conclusion The use of transversus abdominis plane combined general anesthesia in patients undergoing daytime myomectomy can exert a good analgesic effect,have less influence on hemodynamics and stress response,and can inhibit the level of vasoactive factors.