硬膜外麻醉复合静吸全麻下广泛全子宫切除术患者应激水平的变化:与单纯静吸全麻的比较  

Changes of stress levels in patients undergoing extensive hysterectomy under epidural anesthesia combined with intravenous inhalation anesthesia:a comparison with intravenous inhalation anesthesia

作　　者：金楠[1,2] 王寿平[2] Jin Nan;Wang Shouping(Department of Anesthesiology,the Fifth Affiliated Hospital of Guangzhou Medical Univesity,Guangzhou 510700,China;Department of Anesthesiology,the Third Affiliated Hospital of Guangzhou Medical Univesity,Guangzhou 510145,China)

机构地区：[1]广州医科大学附属第五医院麻醉科,广东广州510700 [2]广州医科大学附属第三医院麻醉科,广东广州510150

出　　处：《广州医科大学学报》2017年第4期49-52,共4页Academic Journal of Guangzhou Medical University

摘　　要：目的:比较硬膜外麻醉复合静吸全麻与单纯静吸全麻下广泛全子宫切除术患者围术期应激水平的变化。方法:择期拟行广泛全子宫切除术患者60例,年龄18~75岁,体重50~85 kg,ASA分级Ⅰ~Ⅱ级,按随机数字表法分为两组(n=30):单纯静吸全麻组(GA组)和硬膜外麻醉复合静吸全麻组(GE组),分别于手术开始前(T_1)、手术开始后1 h(T_2)及术毕缝皮时(T3)抽取桡动脉血,且术毕均采用静脉自控镇痛(PCIA)。分别测定两组患者各时间点动脉血的血气分析,并记录各患者于术后0、2、4、8、12、24、48 h VAS镇痛评分;比较两组患者术中各时间点血糖、血乳酸水平变化及术后各时间点的VAS评分。结果:与T1时比较,GA组血糖浓度于T_2、T_3时升高,乳酸浓度于T_2、T_3时升高,GE组血糖浓度于T2、T3时升高,乳酸浓度于T3时升高(P<0.05);与GA组比较,GE组血糖浓度于T_2、T_3时降低,乳酸浓度于T3时降低(P<0.05)。与GA组比较,GE组VAS评分于0、2、4、8、12、24 h降低(P<0.05),于48 h两组VAS评分无明显差异(P>0.05)。结论:与单纯静吸全麻相比,广泛全子宫切除术患者采用硬膜外麻醉复合静吸全麻可降低血糖、血乳酸水平,降低术后VAS评分,降低机体应激水平。Objective：To compare the changes of stress levels in patients undergoing extensive hysterectomy under epidural anesthesia combined with intravenous inhalation anesthesia with intravenous inhalation anesthesia.Methods：Sixty patients scheduled for extensive hysterectomy,aged 18-75 yr,weighing 50-85 kg,of American Society of Anesthesiologists physical status I-Ⅱ,were randomly divided into two groups according to the random number table（n = 30） ：Intravenous inhalation anesthesia group（group GA） and epidural anesthesia combined with intravenous inhalation anesthesia group（group GE）,take blood samples from radial artery respectively before the operation（T1） and 1 hour after the operation begin（T2） and during skin suture when the operation is over（T3）.And all patients were performed with intravenous patient-controlled analgesia（PCIA） after surgery.Arterial blood gas analysis of two groups of patients at different time points were determined,and the patients were recorded at 0,2,4,8,12,24,48 h VAS analgesia score after operation;The blood glucose concentration,blood lactic acid levels and VAS score at each time point were compared between the two groups.Results：Compared with T1,the blood glucose concentration in group GA was higher in T2 and T3,the concentration of lactic acid was higher in T2 and T3,while the blood glucose concentration in group GE was higher in T2 and T3,but the concentration of lactic acid was elevated in T3（P〈0.05）.Compared with the group GA,the blood glucose concentration of group GE was dropping during T2 and T3,and the concentration of lactic acid was dropping during T3（P〈0.05）.Compared with the GA group,the VAS score in group GE was 0,2,4,8,12,24 h decreased（P〈0.05）,and there was no significant difference in VAS scores between the two groups during 48 h（P〈0.05）.Conclusion：Compared with simple intravenous inhalation anesthesia,patients undergoing extensive hysterectomy take epidural anesthesia combined with intravenous inhalation anes

关 键 词：硬膜外麻醉 全身麻醉 广泛全子宫切除术 应激水平 

分 类 号：R614.42[医药卫生—麻醉学]