不同麻醉方式对腹腔镜子宫切除手术患者麻醉质量、术后苏醒认知状态、疼痛视觉模拟评分的影响  

Effects of different anesthesia methods on anesthesia quality,postoperative recovery,cognitive status and visual analogue scale score in patients undergoing laparoscopic hysterectomy

作　　者：时决振 朱文宁[1] 周峰 Shi Juezhen;Zhu Wenning;Zhou Feng(Department of Anaesthesia,Donghai County People′s Hospital of Jiangsu Province,Lianyungang 222300,China;Operating Room,Donghai County People′s Hospital of Jiangsu Province,Lianyungang 222300,China)

机构地区：[1]江苏省东海县人民医院麻醉科,连云港222300 [2]江苏省东海县人民医院手术室,连云港222300

出　　处：《中国医师进修杂志》2023年第10期881-885,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探究不同麻醉方式对腹腔镜子宫切除手术患者麻醉质量、术后苏醒认知状态及疼痛的影响。方法采用前瞻性研究的方法,选取江苏省东海县人民医院2020年7月至2022年12月收治的98例行腹腔镜子宫切除手术患者为研究对象,按照麻醉方式不同分为A组48例和B组50例,A组实施静吸复合麻醉,B组实施静脉全身麻醉复合硬膜外麻醉,比较两组患者苏醒质量,以及术前(T_(0))、术后12 h(T_(1))、术后24 h(T_(2))、术后48 h(T_(3))时刻认知状态、疼痛视觉模拟(VAS)评分,记录A、B组不良反应总发生率。结果B组拔管时间、呼吸恢复时间、苏醒时间均短于A组[(5.69±0.75)min比(10.02±1.26)min、(4.52±0.65)min比(6.59±1.04)min、(8.65±1.12)min比(13.52±1.45)min],差异有统计学意义(P<0.05);T_(0)时刻两组患者简易精神状态检查量表评分比较差异无统计学意义(P>0.05),两组患者T_(1)~T_(3)上述评分均低于T_(0),但B组高于A组[(23.14±1.85)分比(20.36±2.15)分、(25.18±2.47)分比(22.31±2.35)分、(27.05±1.18)分比(26.31±1.01)分],差异有统计学意义(P<0.05);两组患者T_(0)VAS评分比较差异无统计学意义(P>0.05),两组患者T_(1)~T_(3) VAS评分高于T_(0),但B组VAS评分低于A组[(5.17±0.54)分比(6.21±0.75)分、(4.42±0.51)分比(5.63±0.62)分、(2.58±0.34)分比(3.14±0.42)分],差异有统计学意义(P<0.05);两组患者不良反应总发生率比较差异无统计学意义(χ^(2)=0.17,P>0.05)。结论与静吸复合麻醉相比,全身麻醉复合硬膜外麻醉在腹腔镜子宫切除术中具备更好的麻醉质量,可改善术后认知功能,减轻疼痛程度,两种麻醉方式安全性均良好。Objective To explore the effects of different anesthesia methods on anesthesia quality,postoperative recovery,cognitive status and pain in patients undergoing laparoscopic hysterectomy.Methods A prospective study was conducted among 98 patients who underwent laparoscopic hysterectomy in Donghai County People′s Hospital of Jiangsu Province from July 2020 to December 2022.According to different anesthesia methods,the subjects were divided into group A(48 cases,intravenous-inhalation combined anesthesia)and group B(50 cases,intravenous general anesthesia and epidural anesthesia).The recovery quality,cognitive status and VAS scores before operation(T_(0)),at 12 h after operation(T_(1)),24 h after operation(T_(2))and 48 h after operation(T_(3))were compared between the groups.The total incidence rates of adverse reactions in the two groups were recorded.Results The extubation time,respiratory recovery time and awakening time in group B were shorter than those in group A:(5.69±0.75)min vs.(10.02±1.26)min,(4.52±0.65)min vs.(6.59±1.04)min,(8.65±1.12)min vs.(13.52±1.45)min(P<0.05).The two groups had similar mini-mental state examination(MMSE)scores and VAS scores at T_(0)(P>0.05).MMSE scores of the two groups were lower at T_(1)-T_(3) than T_(0).Group B had higher scores than group A at T_(1)-T_(3):(23.14±1.85)scores vs.(20.36±2.15)scores,(25.18±2.47)scores vs.(22.31±2.35)scores,(27.05±1.18)scores vs.(26.31±1.01)scores,P<0.05.VAS scores of the two groups were higher at T_(1)-T_(3) than T_(0).Group B had lower scores than group A:(5.17±0.54)scores vs.(6.21±0.75)scores,(4.42±0.51)scores vs.(5.63±0.62)scores,(2.58±0.34)scores vs.(3.14±0.42)scores,P<0.05.The total incidence rates of adverse reactions in the two groups had no statistical difference(χ^(2)=0.17,P>0.05).Conclusions Compared with intravenous-inhalation combined anesthesia,general anesthesia combined with epidural anesthesia has better anesthesia quality in patients undergoing laparoscopic hysterectomy,which can improve postoperative cognitive

关 键 词：腹腔镜 子宫切除手术 静脉麻醉 硬膜外麻醉 苏醒质量 术后疼痛 

分 类 号：R614[医药卫生—麻醉学]