硬膜外阻滞复合全身麻醉在腹腔镜子宫切除术患者中的应用效果

Application effect of epidural block combined with general anesthesia in patients undergoing laparoscopic hysterectomy

目的分析硬膜外阻滞复合全身麻醉在腹腔镜子宫切除术患者中的应用效果。方法选择我院2019年1月至2020年12月收治的80例腹腔镜子宫切除术患者为研究对象,根据麻醉方式差异将其分为全麻组(40例,全身麻醉)和复合组(40例,硬膜外阻滞复合全身麻醉)。比较两组的生命体征指标、血流动力学指标、血清疼痛介质水平、氧化应激指标、纤溶功能指标、术中及术后不良反应发生情况及麻醉相关指标。结果复合组气腹10 min(T_(1))、气腹30 min(T_(2))、术后5 min(T_(3))时的心率、体温、呼吸频率均显著高于全麻组(P<0.05),且复合组术中的心率、体温、呼吸频率波动幅度小于全麻组。复合组T_(1)、T_(2)、T_(3)时的平均动脉压(MAP)、中心静脉压(CVP)低于全麻组,心脏指数(CI)高于全麻组(P<0.05),且复合组术中的MAP、CVP、CI波动幅度均小于全麻组。术后,两组的血清去甲肾上腺素(NE)、皮质醇(Cor)、前列腺素E_(2)(PGE_(2))水平均较术前升高,血清总抗氧化能力(T-AOC)及超氧化物歧化酶(SOD)水平均较术前降低(P<0.05);术后,复合组的血清NE、Cor、PGE_(2)水平低于全麻组,血清T-AOC及SOD水平高于全麻组(P<0.05)。术后,两组的血清组织纤溶酶原激活物(t-PA)、纤溶酶原激活物抑制剂-1(PAI-1)、D-二聚体(D-D)水平均较术前升高,但复合组低于全麻组(P<0.05)。复合组的术中及术后不良反应总发生率均低于全麻组(P<0.05)。两组的麻醉起效时间比较,差异无统计学意义(P>0.05);复合组的麻醉操作时间、苏醒时间和离室时间均短于全麻组(P<0.05)。结论将硬膜外阻滞复合全身麻醉应用于腹腔镜子宫切除术患者中,可明显减少麻醉对生命体征、血流动力学的影响,并有效减轻应激反应,在保障麻醉安全的同时提高手术安全性,减少不良反应发生。

Objective To analyze the application effect of epidural block combined with general anesthesia in patients undergoing laparoscopic hysterectomy.Methods Eighty patients undergoing laparoscopic hysterectomy admitted in our hospital from January 2019 to December 2020 were selected as the research objects and divided into general anesthesia group(40 cases,general anesthesia)and compound group(40 cases,epidural block combined with general anesthesia)according to the different anesthesia methods.The vital sign indexes,hemodynamic indexes,serum pain mediums levels,oxidative stress indexes,fibrinolytic function indexes,occurrence of adverse reactions during and after operation,and anesthesia related indicators were compared between the two groups.Results At 10 min after pneumoperitoneum(T_(1)),30 min after pneumoperitoneum(T_(2))and 5 min after operation(T_(3)),the heart rate,body temperature and respiratory rate of the compound group were significantly higher than those of the general anesthesia group(P<0.05),and the fluctuation ranges of heart rate,body temperature and respiratory rate during operation in the compound group were smaller than those in the general anesthesia group.At T_(1),T_(2)and T_(3),the mean arterial pressure(MAP)and central venous pressure(CVP)in the compound group were lower than those in the general anesthesia group,and the cardiac index(CI)was higher than that in the general anesthesia group(P<0.05),the fluctuation ranges of MAP,CVP and CI in the compound group were smaller than those in the general anesthesia group.After operation,the levels of serum noradrenaline(NE),cortisol(Cor)and prostaglandin E_(2)(PGE_(2))in both groups were higher than those before operation,while the levels of serum total antioxidant capacity(T-AOC)and superoxide dismutase(SOD)were lower than those before operation(P<0.05);after operation,the levels of serum NE,Cor and PGE_(2)in the compound group were lower than those in the general anesthesia group,and the levels of serum T-AOC and SOD were higher than those in the general anesthesia group(P<0.05).After operation,the levels of serum tissue plasminogen activator(t-PA),plasminogen activation inhibitor-1(PAI-1)and D-dimer(D-D)in both groups were higher than those before operation,but those of the compound group were lower than the general anesthesia group(P<0.05).The total incidences of adverse reactions during and after operation in the compound group were lower than those in the general anesthesia group(P<0.05).There was no significant difference in onset time of anesthesia between the two groups(P>0.05);the anesthesia operation time,recovery time and time out of operating room in the compound group were shorter than those in the general anesthesia group(P<0.05).Conclusion Epidural block combined with general anesthesia applied to patients undergoing laparoscopic hysterectomy can significantly reduce the impact of anesthesia on vital signs and hemodynamics,effectively reduce stress reaction,improve operation safety while ensuring anesthesia safety,and reduce adverse reactions.