脊椎硬膜外麻醉联合静吸复合全身麻醉在老年腹腔镜下全子宫切除术中的应用观察  

Application of Spinal Epidural Anesthesia Combined with Intravenous Inhalation Combined General Anesthesia in Laparoscopic Hysterectomy in the Elderly

作　　者：廉海光 李建[1] 吴红发 林声英 Lian Haiguang;Li Jian;Wu Hongfa;Lin Shengying(Department of Anesthesiology,Maternal and Child Health Hospital of Haikou City,Haikou,Hainan,570203,P.R.China)

机构地区：[1]海口市妇幼保健院麻醉科,海南海口570203

出　　处：《老年医学与保健》2020年第6期980-983,共4页Geriatrics & Health Care

摘　　要：目的评价脊椎硬膜外麻醉联合静吸复合全身麻醉在老年腹腔镜下全子宫切除术中的效果。方法选择2017年11月-2018年11月在海口市妇幼保健院行腹腔镜下全子宫切术的老年患者108例,随机分为观察组(n=54)和对照组(n=54)。观察组采取静吸复合全身麻醉联合脊椎硬膜外麻醉,对照组采取全身麻醉。比较2组术后恢复情况、不同时间儿茶酚胺类激素水平和术前、术后认知情况。结果观察组患者自主呼吸恢复时间、拔管时间、呼之睁眼时间、定向力恢复时间均显著少于对照组,差异有统计学意义(P<0.05)。观察组患者在T3、T4、T5时点的肾上腺素、去甲肾上腺素和多巴胺水平显著低于对照组,差异有统计学意义(P<0.05)。术前2组MMSE评分差异无统计学意义(P>0.05)。术后2组的MMSE评分较术前均降低,且观察组MMSE评分均显著高于对照组,差异有统计学意义(P<0.05)。结论对于老年腹腔镜全子宫切除术患者,静吸复合全身麻醉联合脊椎硬膜外麻醉的临床效果显著,可显著降低患者儿茶酚胺类激素水平,术后认知功能恢复较快,具有一定的临床应用价值。Objective To evaluate the effect of spinal epidural anesthesia combined with intravenous inhalation combined general anesthesia in laparoscopic hysterectomy in the elderly.Methods 108 elderly patients who underwent laparoscopic hysterectomy in Maternal and Child Health Hospital of Haikou City fromNovember 2017 to November 2018 were selected and divided randomly into observation group(n=54)and control group(n=54).The observation group was given spinal epidural anesthesia combined with intravenous inhalation combined general anesthesia,while the control group was given general anesthesia.The postoperative recovery,catecholamine hormone levels at different times,preoperative and postoperative cognitive function were compared between the two groups.Results The recovery time of spontaneous breathing,extubation time,eye opening time and orientation recovery time of the observation group were significantly shorter than those of the control group,and the difference was statistically significant(P<0.05).The levels of epinephrine,norepinephrine and dopamine of the observation group at T3,T4,and T5 were significantly lower than those of the control group,and the difference was statistically significant(P<0.05).There was no significant difference in MMSE scores between the two groups before operation(P>0.05).After operation,the MMSE scores of the two groups were lower than those before the operation,and the MMSE scores of the observation group were significantly higher than those of the control group,the difference was statistically significant(P<0.05).Conclusions For elderly patients undergoing laparoscopic hysterectomy,spinal epidural anesthesia combined with intravenous inhalation combined general anesthesia has a significant clinical effect,which can significantly reduce the level of catecholamine hormones in patients and accelerate the recovery of postoperative cognitive function.It has certain clinical applications value.

关 键 词：老年 腹腔镜下全子宫切除术 静吸复合全身麻醉 脊椎硬膜外麻醉 

分 类 号：R614[医药卫生—麻醉学]