子宫切除术中采用复合麻醉对患者围术期镇痛及卵巢功能的影响  

Effect of compound anesthesia in hysterectomy on perioperative analgesia and ovarian function

作　　者：杨帅 刘婷[2] YANG Shuai;LIU Ting(Department of Anesthesiology,Shangluo International Medical Center Hospital,Shangluo 726099,China)

机构地区：[1]商洛国际医学中心医院麻醉科,陕西商洛726099 [2]商洛市中心医院麻醉科,陕西商洛726099

出　　处：《陕西医学杂志》2022年第7期803-806,共4页Shaanxi Medical Journal

基　　金：国家自然科学基金资助项目(81774113)。

摘　　要：目的:探讨罗哌卡因局部阻滞联合腹横肌平面阻滞对行子宫切除术患者围术期镇痛及卵巢功能的影响,为子宫切除术中的临床麻醉方式提供参考价值。方法:选取腹腔镜子宫切除术104例患者为研究对象,根据麻醉方式的不同分为观察组(52例)与对照组(52例)。对照组患者术中采用罗哌卡因进行局部阻滞,观察组患者术中采用罗哌卡因局部阻滞联合腹横肌平面阻滞进行麻醉。①记录并比较两组患者术中出血量、苏醒时间、拔管时间以及住院时间等情况;②对两组患者的麻醉疗效进行评价;③比较两组患者术前及术后血清炎症因子C反应蛋白(CRP)以及白介素-6(IL-6)的变化情况,同时采用视觉模拟评分法(VAS)对两组患者围术期的疼痛状况进行评估;④比较两组患者术前术后血清促黄体生成素(LH)、促卵泡刺激素(FSH)、雌二醇(E_(2))等卵巢功能相关指标变化情况;⑤观察并记录不良反应发生情况。结果:①观察组患者术中出血量明显低于对照组,苏醒时间、拔管时间以及住院时间均明显少于对照组(均P<0.05);②观察组患者临床疗效高于对照组,但无统计学差异(P>0.05);③术后观察组患者CRP、IL-6水平明显高于对照组(均P<0.05),术后12 h、术后24 h观察组患者VAS评分明显低于对照组(均P<0.05);④术后观察组患者FSH、LH水平明显低于对照组,E_(2)水平明显高于对照组(均P<0.05);⑤观察组患者不良反应发生情况低于对照组,但无统计学差异(P>0.05)。结论:在腹腔镜子宫切除术中,对患者采取罗哌卡因局部阻滞联合腹横肌平面阻滞具有更好的麻醉疗效,能够明显缩短患者术后苏醒时间、拔管时间以及住院时间,显著改善患者体内炎症反应以及疼痛状况,同时能够明显降低对患者卵巢功能影响。Objective:To investigate the effect of local ropivacaine block combined with transversus abdominis plane block on perioperative analgesia and ovarian function in patients undergoing hysterectomy,and to provide reference value for clinical anesthesia in hysterectomy.Methods:A total of 104 patients undergoing laparoscopic hysterectomy were selected as the research objects,and they were divided into observation group(52 cases)and control group(52 cases)according to different anesthesia methods.The patients in the control group were treated with ropivacaine for local block during operation,while the patients in the observation group were treated with ropivacaine local block combined with transversus abdominis plane block for anesthesia.The intraoperative blood loss,recovery time,extubation time and hospitalization time of the two groups were recorded and compared.And the anesthesia efficacy of the two groups was evaluated.The changes of serum inflammatory factors C-reactive protein and interleukin-6 before and after surgery were compared between the two groups.At the same time,the VAS was used to evaluate the perioperative pain status of the two groups.The changes of serum luteinizing hormone(LH),follicle stimulating hormone(FSH),and estradiol(E_(2))before and after surgery were compared between the two groups.The occurrence of adverse reactions was observed and recorded.Results:The intraoperative blood loss in the observation group was significantly lower than that in the control group,and the recovery time,extubation time and hospital stay were significantly shorter than those in the control group(all P<0.05).The clinical efficacy of the observation group was higher than that of the control group,but there was no significant difference(P>0.05).The levels of CRP and IL-6 in the observation group after operation were significantly higher than those in the control group(all P<0.05),and the VAS scores in the observation group at 12 and 24 hours after operation were significantly lower than those in the control group(al

关 键 词：子宫切除术 罗哌卡因 腹横肌平面阻滞 围术期镇痛 卵巢功能 

分 类 号：R614[医药卫生—麻醉学]