摘要
目的探讨全身麻醉联合硬膜外麻醉对腹腔镜子宫切除术患者应激反应及手术效果的影响。方法选取宜宾市第三人民医院2014年12月至2016年5月在腹腔镜下行子宫切除术的患者86例,按照随机数字表法将患者随机分为观察组和对照组,每组43例,观察组实施全身麻醉联合硬膜外麻醉,对照组实施全身麻醉。记录两组患者在麻醉前(T_1)、麻醉后5min(T_2)、术后即刻(T_3)、术后24h(T_4)收缩压(SBP)、舒张压(DBP)以及心率(HR)的变化。分别在T_1-T_4时间点测定指尖血糖,抽取外周静脉血测定血清D-二聚体(D-D)、纤维蛋白降解产物纤溶酶原激活物抑制剂-1(PAI-1)、组织型纤溶酶原激活物(t-PA)水平。记录两组术后自主呼吸恢复时间、拔管时间、苏醒时间以及瑞芬太尼用量。结果两组患者在T_1、T_2时间点SBP、DBP、HR水平比较差异无统计学意义(P>0.05),观察组在T_3、T_4时间点SBP、DBP、HR明显低于对照组(P<0.05)。观察组在T_3、T_4时间点血糖、PAI-1、t-PA水平明显低于对照组(P<0.05)。观察组患者术后自主呼吸恢复时间、拔管时间、苏醒时间明显短于对照组,瑞芬太尼用量也少于对照组(P<0.05)。结论全身麻醉联合硬膜外麻醉在腹腔镜子宫切除术中能有效地抑制应激反应,缩短术后拔管时间和苏醒时间。
Objective To investigate the influence of general anesthesia combined with epidural anesthesia on stress response and operation effect in the patients with laparoscopic hysterectomy.Methods Eighty-six patients with laparoscopic hysterectomy in the Yibin Municipal Third People′s Hospital from December 2014 to May 2016 were selected and randomly divided into the observation group and control group according to the random number table method,43 cases in each group.General anesthesia combined with epidural anesthesia was used in the observation group and the control group was implemented the general anesthesia.Systolic blood pressure（SBP）,diastolic blood pressure（DBP）and heart rate（HR）in the two groups were recorded before anesthesia（T_1）,at 5 min after anesthesia（T_2）,immediately after operation（T_3）and at postoperative 24h（T_4）.The blood glucose,D-dimer（D-D）and fibrinogen degradation products PAI-1 and t-PA levels were measured from the time points of T_1-T_4.The recovery time of spontaneous breathing,extubation time,recovery time and remifentanil dosage were recorded in the two groups.Results There was no statistically significant difference in SBP,DBP and HR at T_1,T_2 between the two groups（P0.05）.SBP,DBP and HR at T_3 and T_4 in the observation group were significantly lower than those in the control group（P0.05）.The blood glucose,PAI-1 and t-PA at T_3,T_4 in the observation group were significantly lower than those in the control group（P0.05）.The postoperative spontaneous breathing recovery time,extubation time and recovery time in the observation group were significantly shorter than those in the control group（P0.05）.The remifentanil dosage in the observation group was less than that in the control group（P0.05）.Conclusion General anesthesia combined with epidural anesthesia in laparoscopic hysterectomy can effectively inhibit the stress response,and shortens the extubation time and recovery time.
出处
《检验医学与临床》
CAS
2017年第17期2562-2564,共3页
Laboratory Medicine and Clinic
关键词
腹腔镜
全身麻醉
硬膜外麻醉
子宫切除术
laparoscope
general anesthesia
epidural anesthesia
hysterectomy
