全麻复合硬膜外麻醉在腹腔镜下子宫肌瘤切除术中的应用效果研究

A study on the effect of general anesthesia combined with epidural anesthesia in laparoscopic myomectomy

目的探讨腹腔镜下子宫肌瘤切除术采取全身麻醉(全麻)复合硬膜外麻醉的临床效果。方法80例接受腹腔镜下子宫肌瘤切除术的患者,按随机数字表法分为对照组和研究组,各40例。对照组术中采用全身麻醉,研究组术中采用全身麻醉复合硬膜外麻醉。比较两组患者的心率(HR)、平均动脉压(MAP)、呼吸恢复时间、苏醒时间、拔管时间、术后视觉模拟评分法(VAS)评分、肌松效果及不良反应发生率。结果麻醉诱导前,两组HR、MAP比较差异无统计学意义(P>0.05);切皮时、气腹20 min、术毕,两组HR、MAP均高于麻醉诱导前,但研究组HR、MAP均低于对照组,差异有统计学意义(P<0.05)。研究组呼吸恢复时间(8.36±1.67)min、苏醒时间(8.58±2.13)min、拔管时间(16.36±2.58)min均短于对照组的(13.35±2.42)、(14.35±2.53)、(21.68±3.52)min,术后VAS评分(4.01±0.43)分低于对照组的(5.26±0.63)分,差异有统计学意义(P<0.05)。研究组肌松优良率95.00%高于对照组的77.50%,差异有统计学意义(P<0.05)。研究组不良反应发生率2.50%低于对照组的20.00%,差异有统计学意义(P<0.05)。结论在腹腔镜下子宫肌瘤切除术中应用全身麻醉复合硬膜外麻醉可缩短麻醉恢复时间,对应激指标影响较小,安全性较高,建议推广应用。

Objective To discuss the clinical effect of general anesthesia combined with epidural anesthesia in laparoscopic myomectomy.Methods A total of 80 patients who underwent laparoscopic myomectomy were randomly divided into control group and research group,with 40 cases in each group.The control group received general anesthesia,while the research group received general anesthesia combined with epidural anesthesia.Both groups were compared in terms of heart rate(HR),mean arterial pressure(MAP),recovery time of respiration,awakening time,extubation time,postoperative visual analogue scale(VAS)score,muscle relaxant effect,and incidence of adverse reactions.Results Before anesthesia induction,there was no statistically significant difference in HR and MAP between the two groups(P>0.05).At the time of skin incision,20 min after pneumoperitoneum,and at the end of surgery,HR and MAP in both groups were higher than those before induction of anesthesia in this group,but HR and MAP in the research group were lower than those in the control group,and the differences were statistically significant(P<0.05).In the research group,the recovery time of respiration was(8.36±1.67)min,the awakening time was(8.58±2.13)min,and the extubation time was(16.36±2.58)min,which were shorter than those of(13.35±2.42),(14.35±2.53)and(21.68±3.52)min in the control group;postoperative VAS score of(4.01±0.43)points in the research group was lower than that of(5.26±0.63)points in the control group;the differences were statistically significant(P<0.05).The excellent rate of muscle relaxation was 95.00%in the research group,which was higher than that of 77.50%in the control group,and the difference was statistically significant(P<0.05).Conclusion The application of general anesthesia combined with epidural anesthesia in laparoscopic hysteromyectomy can shorten the recovery time of anesthesia,has little influence on the stress indexes,and has high safety,so it is recommended to be popularized.