腰硬联合麻醉与双腔喉罩通气全麻对腹腔镜下全子宫切除术患者术后恢复和疼痛程度的影响

Effects of Combined Spinal Epidural Anesthesia and Double-lumen Laryngeal Mask Ventilation General Anesthesia on Postoperative Recovery and Pain in Patients Undergoing Laparoscopic Total Hysterectomy

目的分析腰硬联合麻醉与双腔喉罩通气全麻对腹腔镜下全子宫切除术患者术后恢复和疼痛程度的影响。方法选取2021年3月—2022年11月徐州市妇幼保健院收治的行腹腔镜子宫全切术的患者68例,采用随机数表法分为两组,各34例。对照组采用双腔喉罩通气全麻,观察组采用腰硬联合麻醉,比较两组不同时间点的血流动力学指标水平,术后恢复情况,术后1、2、4 h疼痛评分,不良反应发生率。结果观察组麻醉后5 min、手术开始后15 min、手术结束即刻的心率、平均动脉压均低于对照组,差异有统计学意义(P<0.05);观察组苏醒时间(6.23±2.49)min、肛门排气时间(9.11±2.25)h、下床活动时间(20.13±3.23)h均短于对照组,差异有统计学意义(t=10.955、3.936、3.746,P<0.05);观察组术后1、2、4 h视觉模拟评分法评分均低于对照组,差异有统计学意义(P<0.05);观察组总不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论腹腔镜下全子宫切除术患者中,应用腰硬联合麻醉可有效稳定患者手术过程中的血流动力学指标水平,促进术后恢复,降低术后疼痛评分,减少不良反应的发生。

Objective To analyze the effects of combined spinal epidural anesthesia and double-lumen laryngeal mask ventilation general anesthesia on postoperative recovery and pain in patients undergoing laparoscopic total hysterectomy.Methods A total of 68 patients undergoing laparoscopic total hysterectomy who were admitted to Xuzhou Maternal and Child Health Hospital from March 2021 to November 2022 were selected and randomly divided into two groups by random number table method,34 cases each group.The control group received general anesthesia with double-chamber laryngeal mask ventilation,and the observation group received combined spinal-epidural anesthesia.The levels of hemodynamic indicators at different time points;postoperative recovery;postoperative pain scores at 1,2,and 4 h;and the incidence of adverse reactions were compared between the two groups.Results The heart rate and mean arterial pressure of the observation group were lower than those of the control group at 5 min after anesthesia,15 min after the operation began,and immediately after the operation ended,the difference was statistically significant(P<0.05).The wake-up time(6.23±2.49)min,anal exhaust time(9.11±2.25)h,and time to get out of bed(20.13±3.23)h in the observation group were all shorter than those in the control group,the difference was statistically significant(t=10.955,3.936,3.746,P<0.05).The visual analog scale scores of the observation group were lower than those of the control group at 1,2,and 4 h after operation,the difference was statistically significant(P<0.05).The total incidence of adverse reactions in the observation group was lower than that in the control group,the difference was statisti cally significant(P<0.05).Conclusion In patients undergoing total laparoscopic hysterectomy,combined spinal epidural anesthesia can effectively stabilize the hemodynamic index levels during the operation,promote postoperative recovery,and reduce postoperative pain scores and adverse reactions.