硬膜外阻滞复合全身麻醉对腹腔镜子宫切除术围术期疼痛介质的影响  

Effect of epidural block combined with general anesthesia on perioperative pain mediators in patients undergoing laparoscopic hysterectomy

作　　者：鲍春燕 BAO Chunyan(Department of Anesthesiology,Maternal and Child Health Hospital of Changning District,Shanghai 200050,China)

机构地区：[1]上海市长宁区妇幼保健院麻醉科,上海200050

出　　处：《检验医学与临床》2020年第8期1047-1050,共4页Laboratory Medicine and Clinic

摘　　要：目的探讨硬膜外阻滞复合全身麻醉对腹腔镜子宫切除术围术期疼痛介质的影响。方法将92例在该院行腹腔镜子宫切除术的患者分为观察组和对照组,每组各46例。观察组患者行硬膜外阻滞复合全身麻醉手术。对照组患者采用静脉全身麻醉手术。记录两组患者的手术情况。记录两组患者术前(T0)、术后6 h(T1)、术后12 h(T2)、术后24 h(T3)、术后48 h(T4)生命体征变化情况,包括心率(HR)、平均动脉压(MAP)、血氧饱和度(SPO 2);检测患者前列腺素E2(PGE2)、5-羟色胺(5-HT)、P物质(SP)水平。应用视觉模拟评分法(VAS)评估患者疼痛程度。记录两组患者围术期并发症发生情况。结果两组患者手术时间、术中出血量、麻醉时间比较,差异均无统计学意义(P>0.05);观察组患者苏醒时间、芬太尼剂量、异丙酚剂量较对照组少,差异均有统计学意义(P<0.05)。对照组患者在T1、T2时的HR、MAP均明显升高,且高于同一时刻的观察组,差异均有统计学意义(P<0.05);观察组患者在T0~T4时HR、MAP、SPO 2差异均无统计学意义(P>0.05)。两组患者在T1~T4时PGE2、5-HT、SP水平及VAS评分均明显升高,差异均有统计学意义(P<0.05);观察组患者在T1~T3时PGE2、5-HT、SP水平及VAS评分均低于对照组,差异均有统计学意义(P<0.05)。观察组患者并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论硬膜外阻滞复合全身麻醉可保持腹腔镜子宫切除术患者的生命体征稳定,降低围术期疼痛介质水平,降低并发症发生率。Objective To investigate the effect of epidural block combined with general anesthesia on perioperative pain mediators in patients undergoing laparoscopic hysterectomy.Methods A total of 92 patients undergoing laparoscopic hysterectomy in the hospital were divided into the observation group and the control group,with 46 cases in each group.The observation group received epidural block combined with general anesthesia.The control group received general intravenous anesthesia.The operation conditions of the two groups were recorded.The changes of vital signs including heart rate(HR),mean arterial pressure(MAP),blood oxygen saturation(SPO 2),prostaglandin E2(PGE2),5-hydroxytryptamine(5-HT)and substance P(SP)were recorded before operation(T0),6 h after operation(T1),12 h after operation(T2),24 h after operation(T3)and 48 h after operation(T4).Visual analogue scale(VAS)was used to evaluate the degree of pain.The perioperative complications of the two groups were recorded.Results There was no significant difference in operation time,bleeding volume and anesthesia time between the two groups(P>0.05).The wake-up time and dosages of fentanyl and propofol in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).HR and MAP in the control group at T1 and T2 increased significantly and were higher than those in the observation group at the same time,and the differences were statistically significant(P<0.05).There was no significant difference in HR,MAP and SPO 2 at T0 to T4 in the observation group(P>0.05).From T1 to T4,the scores of PGE2,5-HT,SP and VAS in the two groups increased significantly,and the differences were statistically significant(P<0.05).From T1 to T3,the scores of PGE2,5-HT,SP and VAS in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).The incidence of complications in the observation group was lower than that in the control group,and the difference was statistically

关 键 词：硬膜外阻滞 全身麻醉 腹腔镜子宫切除术 疼痛介质 围术期 

分 类 号：R713.4[医药卫生—妇产科学]