硬膜外腔阻滞麻醉联合全身麻醉对妇科肿瘤腹腔镜手术患者血流动力学、应激反应及术后恢复影响  

Effects of epidural block anesthesia combined with general anesthesia during laparoscopic surgery for gynecological tumors of patients on their hemodynamics,stress response,and postoperative recovery

作　　者：刘斌[1] 王金星[1] 何文学[1] 赵宇[1] LIU Bin;WANG Jinxing;HE Wenxue;ZHAO Yu(Panzhihua Central Hospital,Panzhihua,Sichuan Province,617067)

机构地区：[1]四川省攀枝花市中心医院,617067

出　　处：《中国计划生育学杂志》2022年第11期2624-2628,2633,共6页Chinese Journal of Family Planning

摘　　要：目的:探究硬膜外腔阻滞麻醉联合全身麻醉对妇科肿瘤腹腔镜手术患者血流动力学、苏醒时间及不良反应的影响。方法:回顾性分析2020年1月-2021年1月本院收治的行妇科肿瘤腹腔镜手术患者96例临床资料,按照麻醉方式不同分为联合组(硬膜外腔阻滞麻醉联合全身麻醉)和对照组(全身麻醉)各48例,比较两组手术情况,麻醉前(T0)、插管时(T1)、气腹停止后30min(T2)、术后24h(T3)血流动力学[心率(HR)、收缩压(SBP)、舒张压(DBP)、氧饱和度(SpO_(2))]、凝血功能[部分激活凝血活酶时间(APTT)、凝血酶原时间(PT)]、血糖水平,术前和术后1d认知情况[简易精神状况检查(MMSE)、连线测验(TMT)],比较两组不良反应。结果:两组手术时间、气腹时间无差异(P>0.05),联合组苏醒时间(16.7±5.7min)低于对照组(26.1±8.8min)(P<0.05)。T1、T2时两组HR、SpO_(2)水平和联合组SBP、DBP水平,与T0时比较无差异,T2时对照组SBP、DBP与T0时比较无差异(均P>0.05),T1时对照组SBP、DBP高于T0时(P<0.05);T0、T1、T2时两组HR、SpO_(2),T0、T2时两组SBP、DBP比较均无差异(均P>0.05),T1时联合组SBP、DBP水平低于对照组(P<0.05)。T0、T1、T2、T3时两组PT水平,T0、T1、T3时两组APTT水平比较均无差异(P>0.05),T2时联合组APTT水平高于对照组(P<0.05)。T0时两组血糖水平无差异(P>0.05),T2、T3时联合组血糖水平低于对照组(P<0.05)。术后1d,联合组MMSE评分(26.47±1.15分)高于对照组(25.25±1.29分),TMT(41.69±5.01s)低于对照组(45.11±4.94s)(均P<0.05)。两组不良反应发生无差异(P>0.05)。结论:妇科肿瘤腹腔镜手术硬膜外腔阻滞麻醉联合全身麻醉可使患者血流动力学更为稳定,苏醒时间缩短,对凝血功能、应激反应和认知功能的影响降低。Objective:To explore the effects of epidural block anesthesia combined with general anesthesia during laparoscopic surgery for gynecological tumors of patients on their hemodynamics,awakening time,and adverse reactions.Methods:The clinical data of 96 patients undergoing laparoscopic surgery of gynecological tumors between January 2020 and January 2021 were analyzed retrospectively.According to different anesthesia methods,these patients were divided into group A(48 patients with epidural block anesthesia combined with general anesthesia)and group B(48 patients with general anesthesia).The surgical status,the hemodynamics indexes,such as heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),oxygen saturation(SpO_(2)),the coagulation function indexes,such as partial activated thromboplastin time(APTT)and prothrombin time(PT),the blood glucose level,the cognitive status before surgery and in 1 d after surgery,such as Mini-Mental State Examination(MMSE)and Trial Making Test(TMT),of the patients at before anesthesia(T0),during intubation(T1),30min after pneumoperitoneum cessation(T2),and 24h after surgery(T3)were compared between the two groups.The occurrence of adverse reactions of the patients was compared between the two groups.Results:There were no significant differences in the operation time and the pneumoperitoneum time of the patients between the two groups(P>0.05).The recovery time(16.7±5.7min)of the patients in group A was significantly lower than that(26.1±8.8min)of the patients in group B(P<0.05).The HR value and SpO_(2) level of the patients in both groups,the values of SBP and DBP of the patients in group A at T1 and T2 had no significantly different from those of the patients at T0.The values of SBP and DBP of the patients in group B at T2 had no significantly different from those at T0(all P>0.05).The values of SBP and DBP of the patients in group B at T1 were significantly higher than those of the patients at T0(P<0.05).There were no significant differences in the values of HR,Sp

关 键 词：妇科肿瘤 腹腔镜手术 硬膜外腔阻滞麻醉 全身麻醉 血流动力学 应激反应 认知功能 

分 类 号：R614[医药卫生—麻醉学] R737.3[医药卫生—外科学]