全凭静脉麻醉和静吸复合麻醉对妇科腹腔镜术胃肠动力影响

Influence of the total intravenous anesthesia and the combined intravenous-inhalation anesthesia used during the laparoscopic gynecological surgery of patients on their gastrointestinal motility

目的:探讨不同麻醉方法对妇科腹腔镜手术的麻醉效果,分析对患者胃动素、术后恶心呕吐等胃肠动力的影响。方法:选取2021年5月—2021年11月本院收治的120例接受妇科腹腔镜手术患者,按照麻醉方式随机均分为全凭静脉麻醉(TIVA)组60例、静吸复合麻醉(CIVIA)组60例。比较两组麻醉效果、胃动素水平以及术后恶心呕吐发生率。结果:CIVIA组术后自主呼吸恢复时间(9.27±2.31 min)、术后睁眼时间(10.15±2.04 min)、拔管时间(13.52±2.78 min)和定向恢复时间(16.08±2.49 min)均短于TIVA组(12.09±1.95 min、13.72±2.26 min、15.34±2.63 min、19.63±2.52 min),术毕和术后24h胃动素水平(354.23±79.05 pg/ml、318.62±69.48 pg/ml)高于TIVA组(321.47±82.41 pg/ml、290.56±76.32 pg/ml),恶心呕吐发生率(26.7%)高于TIVA组(11.7%)(均P<0.05);术后肛门首次排气时间两组无差异(P>0.05)。结论:相比TIVA方式,选择CIVIA的妇科腹腔镜手术患者的苏醒和恢复更快,但须注意药物控制胃动素的释放,以有效降低术后恶心呕吐等不良胃肠反应的发生。

Objective:To explore the effect of the different anesthesia methods during laparoscopic gynecological surgery of patients,and to compare the influence of the different anesthesia methods on the motilin and the postoperative gastrointestinal motility,such as nausea and vomiting,of the patients.Methods:120 patients who wanted gynecological laparoscopic surgery were selected and were randomly divided into two groups(60 cases in each group) according to the different anesthesia methods from May to November 2021.The patients in the control group were given total intravenous anesthesia(TIVA) and the patients in the study group were given combined intravenous-inhalation anesthesia(CIVIA).The anesthetic effect,the motilin level,and the incidences of postoperative nausea and vomiting of the patients were compared between the two groups.Results:The recovery time of spontaneous respiration(9.27±2.31 min),the time of eye opening(10.15±2.04 min),the extubation time(13.52±2.78 min),and the orientation recovery time(16.08±2.49 min) of the patients in the study group were all significantly shorter than those(12.09±1.95 min,13.72±2.26 min,15.34±2.63 min,and 19.63±2.52 min) of the patients in the control group.The motilin levels of the patients after operation(354.23±79.05 pg/ml) and at 24h after operation(318.62±69.48 pg/ml) of the patients in the study group were all significantly higher than those(321.47±82.41 pg/ml and 290.56±76.32 pg/ml) of the patients in the control group.The incidence of nausea and vomiting(26.7%) of the patients in the study group was significantly higher than that(11.7%) of the patients in the control group(all P<0.05).There was no significant difference in the time of the first anal exhaust of the patients between the two groups(P<0.05).Conclusion:Compared with those of TIVA,the patients with laparoscopic gynecological surgery who choose CIVIA have the faster awakening and recovery,but the motilin release by the drug control of the patients should be paid attention to,so as to effectively reduce the incidences of postoperative nausea and vomiting and other adverse gastrointestinal reactions of the patients.