蛛网膜下腔阻滞联合硬膜外镇痛在子宫肌瘤切除术患者中的应用

Application of subarachnoid block combined with epidural analgesia in patients with hysteromyomectomy

目的:研究蛛网膜下腔阻滞联合硬膜外镇痛对子宫肌瘤切除术患者中的应用价值。方法:我院2021年1月至2023年5月妇科60例行子宫肌瘤切除术患者,以简单随机分组法将其分为对照组(30例)和观察组(30例)。对照组给予蛛网膜下腔阻滞+静脉自控镇痛,观察组给予蛛网膜下腔阻滞+硬膜外镇痛。对比两组术后不同时间点血流动力学指标[心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2)],Ramasay镇静评分、疼痛视觉模拟评分(VAS)、质量恢复量表(QoR-15)评分、不良反应及镇痛满意率。结果:术后6 h、术后12 h和术后24 h,观察组SpO2均高于对照组,HR、MAP均低于对照组(P<0.05),同时Ramasay镇静评分高于对照组,VAS评分均低于对照组(P<0.05)。观察组术后身体舒适度、情绪状态、疼痛及QoR-15总分均高于对照组(P<0.05)。观察组不良反应总发生率低于对照组(P<0.05)。结论:蛛网膜下腔阻滞联合硬膜外镇痛可改善子宫肌瘤切除术患者镇痛效果,改善其术后恢复质量,安全可靠。

Objective:To study the application value of subarachnoid block combined with epidural analgesia in patients with hysteromyomectomy.Methods:From January 2021 to May 2023,60 patients with hysteromyomectomy in gynecology department of our hospital were divided into control group(30 cases)and observation group(30 cases)by simple randomized method.The control group was given subarachnoid block+controlled intravenous analgesia,and the observation group was given subarachnoid block+epidural analgesia.Hemodynamic indexes(heart rate(HR),mean arterial pressure(MAP),blood oxygen saturation(SpO2)),Ramasay sedation score,visual analogue pain scale(VAS),Quality Recovery Scale(QoR-15)score,adverse reactions and analgesia satisfaction rate were compared between the two groups at different time points after surgery.Results:At 6 h,12 h and 24 h after surgery,SpO2,HR and MAP in observation group were all higher than those in control group(P<0.05),while Ramasay sedation score and VAS score in observation group were higher than those in control group(P<0.05).The physical comfort,emotional state,pain and total score of QoR-15 in the observation group were higher than those in the control group(P<0.05).The total incidence of adverse reactions in observation group was lower than that in control group(P<0.05).Conclusion:Subarachnoid block combined with epidural analgesia can improve the analgesic effect of patients with hysteromyomectomy,improve the quality of postoperative recovery,and is safe and reliable.