全麻复合硬膜外麻醉对腹腔镜下阴式子宫全切术中血流动力学及血清纤溶功能影响  

The influence of general anesthesia combined with epidural anesthesia in laparoscopic assisted vaginal hysterectomy of women with uterine benign disease on their hemodynamics and serum D-D, PAI 1 and tPA levels

作　　者：苏更生 SU Gengsheng(The Second People's Hospital of Xining,Qinghai Province,810003)

机构地区：[1]青海省西宁市第二人民医院

出　　处：《中国计划生育学杂志》2019年第9期1166-1169,共4页Chinese Journal of Family Planning

摘　　要：目的:探讨全麻复合硬膜外麻醉对腹腔镜辅助下阴式子宫全切术中血流动力学及血清纤溶功能指标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)水平影响。方法:2014年5月—2016年9月本院收治的子宫良性疾病患者72例,随机数字表法分为观察组(n=36)与对照组(n=36)。观察组采取全麻复合硬膜外麻醉,对照组采取静吸复合全麻。比较两组麻醉维持药物用量、麻醉恢复效果、不同时间段[麻醉前(T1)、麻醉5 min(T2)、拔管后(T3)]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变化、不良反应发生率。结果:术中观察组丙泊酚、维库溴铵用量以及手术后苏醒时间、气管导管撤管时间、恢复自主呼吸时间均小于对照组(P<0.05);HR、MAPT1时期观察组与对照组比较无差异(P>0.05),T2、T3时期观察组低于对照组(P<0.05);血清t PA、PAI 1、D D水平T1时期观察组与对照组比较无差异(P>0.05),T2、T3时期观察组低于对照组(P<0.05);观察组心动过速率(13.9%)、呕吐恶心率(16.7%)、躁动率(8.3%)低于对照组(36.1%、38.9%、27.8%)(均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,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 influence of general anesthesia combined with epidural anesthesia in laparoscopic assisted vaginal hysterectomy of women with uterine benign disease on their hemodynamics and levels of serum tissue type plasminogen activator(tPA),plasminogen activator inhibitor 1(PAI 1),D dimer(D D).Methods:From May 2014 to September 2016,72 women with uterine benign disease were randomly divided into control group and study group(36 cases in each group).The women in the control group were treated by intravenous anesthesia combined with general anesthesia,and the women in the study group received epidural anesthesia combined with general anesthesia.The amount of anesthesia drug for maintaining anesthesia,the recovery situation after anesthesia,the hemodynamic parameters[Heart rate(HR),mean arterial pressure(MAP)]and serum fibrinolytic function index(t PA,PAI 1,D D)during different time periods before anesthesia(T1),5 min after anesthesia(T2),immediately after extubation(T3)],and the adverse reaction rate of women were compared between the two groups.Results:The amount of propofol and vecuronium used for women in the study group during operation was significant less than that for women in the control group(P<0.05).The recovery time,tracheal tube withdrawal time,and time of spontaneous breathing recovery of women in the study group were significant less than those of women in the control group(P<0.05).There were no significant different in HR,MAP and the levels of serum tPA,PAI 1 and D D of women between the two groups at T1(P>0.05),but HR,MAP,and the levels of serum tPA,PAI 1 and D D of women in the study group were significant lower than those of women in the control group at T2 and T3(P<0.05).The rates of tachycardia,vomiting and nausea,and restless of women in the study group were 13.9%,16.7%,and 8.3%,respectively,which were significant lower than those(36.1%,38.9%,and 27.8%,respectively)of women in the control group (P<0.05). Conclusion: The general anesthesia combined with epidural anesthesia used

关 键 词：子宫良性疾病 全麻 硬膜外麻醉 腹腔镜辅助下阴式子宫全切术 血流动力学 纤溶功能 

分 类 号：R61[医药卫生—外科学]