子宫良性疾病患者全麻复合硬膜外麻醉行腹腔镜辅助下阴式子宫全切术对血流动力学及血清D-D、PAI-1、t-PA水平影响研究  

Effects of general anesthesia combined with epidural anesthesia on hemodynamics and serum D-D,PAI-1 and t-PA levels in patients undergoing uterine benign disease under laparoscopic assisted vaginal hysterectomy

作　　者：边春生 王惠军 Bian Chunsheng;Wang Huijun(Department of Anesthesiology,Beijing Chaoyang Emergency Medical Center,Beijing 100122)

机构地区：[1]北京朝阳急诊抢救中心麻醉科,北京100122 [2]北京同仁医院麻醉科,北京100122

出　　处：《陕西医学杂志》2018年第5期564-567,共4页Shaanxi Medical Journal

基　　金：北京市科学技术委员会科研计划项目(D151100004912008)

摘　　要：目的:探讨全麻复合硬膜外麻醉对子宫良性疾病患者行腹腔镜辅助下阴式子宫全切术中血流动力学及血清组织型纤溶酶原激活物(t-PA)、纤溶酶原激活物抑制物-1(PAI-1)、D-二聚体(D-D)水平的变化。方法:选取72例子宫良性疾病患者,随机数字表法分为对照组(n=36)与研究组(n=36)。对照组采取静吸复合全麻,研究组采取全麻复合硬膜外麻醉。统计对比两组麻醉维持药物用量、麻醉恢复效果、不同时间段[麻醉前(T_1)、麻醉5min(T_2)、拔管后(T_3)]血流动力学指标[心率(HR)、平均动脉压(MAP)]及血清纤溶功能指标(t-PA、PAI-1、D-D)水平变化情况、不良反应发生率。结果:研究组丙泊酚、维库溴铵用量较对照组少,差异有统计学意义(P<0.05);研究组苏醒时间、气管导管撤管时间、恢复自主呼吸时间较对照组少,差异有统计学意义(P<0.05);研究组T_1时期HR、MAP与对照组比较,差异无统计学意义(P>0.05),T_2、T_3时期两组HR、MAP较T_1时期增高,但研究组低于对照组,差异有统计学意义(P<0.05);研究组T_1时期血清t-PA、PAI-1、D-D水平与对照组比较,差异无统计学意义(P>0.05),T_2、T_3时期两组血清t-PA、PAI-1、D-D水平较T_1时期增高,但研究组低于对照组,差异有统计学意义(P<0.05);研究组心动过速率13.89%(5/36)、呕吐恶心率16.67%(6/36)、躁动率8.33%(3/36)较对照组[36.11%(13/36)、38.89%(14/36)、27.78%(10/36)]低,差异有统计学意义(P<0.05)。结论:子宫良性疾病患者行腹腔镜辅助下阴式子宫全切术中采用全麻复合硬膜外麻醉可有效减少麻醉药物用量,麻醉恢复效果好,术中血流动力学较稳定,且对患者纤溶功能影响较小,不良反应发生率低,安全性较高。Objective:To investigate the effects of general anesthesia combined with epidural anesthesia on hemodynamics and serum tissue-type plasminogen activator(t-PA),plasminogen activator inhibitor-1(PAI-1),D-dimer(D-D)levels.Methods:72 cases of uterine benign disease patients in our hospital were randomly divided into control group and study group,36 cases each group.The control group was treated with intravenous anesthesia combined with general anesthesia,the study group received general anesthesia combined with epidural anesthesia.Anesthesia was maintained with the amount of drugs,anesthesia recovery effect,different time periods[Anesthesia(T 1),anesthesia 5 min(T 2),extubation(T 3)],hemodynamic parameters[Heart rate(HR),mean arterial pressure(the MAP)]and serum fibrinolytic function index(t-PA,PAI-1,D-D)and the adverse reaction rate of the two groups were compared.Results:The amount of propofol and vecuronium in the study group was less than that in the control group(P<0.05);The recovery time,tracheal tube withdrawal time,recovery of spontaneous breathing time of the study group was less than the control group,the difference was statistically significant(P<0.05);There was no significant difference in HR and MAP between the study group and the control group at T 1 time point(P>0.05),at T 2 and T 3,HR and MAP were higher than it at T1,but the study group was lower than the control group,the difference was statistically significant(P<0.05);There was no significant difference in the levels of ser um t-PA,PAI-1 and D-D between the study group and the control group at 1(P>0.05),at the T 2,T 3 period,the levels of serum t-PA,PAI-1 and D-D in the two groups were higher than those at T1 period,but the study group was lower than the control group,the difference was statistically significant(P<0.05);The tachycardia rate was 13.89%(5/36),the rate of vomiting and nausea was 16.67%(6/36)and the restless rate was 8.33%(3/36)in the study group,compared with the control group[36.11%(13/36),38.89%(14/36),27.78%(10/36)],the difference

关 键 词：麻醉 全身 麻醉 硬膜外 子宫切除术 腹腔镜检查 血流动力学 纤溶功能 

分 类 号：R614.2[医药卫生—麻醉学]