硬膜外阻滞复合全身麻醉在腹腔镜子宫切除术中的应用研究  

Application of Epidural Block Combined with General Anesthesia in Laparoscopic Hysterectomy

作　　者：刘彤 林威威 陈本祯[2] 陈东文 阳旭 高洪光 周龑 鄢伟 LIU Tong;LIN Weiwei;CHEN Benzhen;CHEN Dongwen;YANG Xu;GAO Hongguang;ZHOU Yan;YAN Wei(Department of Anesthesiology,the Third Affiliated Hospital of Chengdu Medical College Pidu District People's Hospital,Chengdu 611730,China;Department of Anestesiology,Sichuan Maternal and Child Health Hospital,Chengdu 610045,China;Department of Anesthesiology,the Fourth West China Hospital of Sichuan University,Chengdu 610044,China;Department of Neurosurgery,Qingdao Hospital of Traditional Chinese Medicine Haici Hospital of Qingdao City,Qingdao,Shandong 266033,China)

机构地区：[1]成都医学院第三附属医院·成都市郫都区人民医院麻醉科,成都611730 [2]四川省妇幼保健院麻醉科,成都610045 [3]四川大学华西第四医院麻醉科,成都610044 [4]青岛市中医医院市海慈医院神经外科,山东青岛266033

出　　处：《临床误诊误治》2023年第8期117-121,共5页Clinical Misdiagnosis & Mistherapy

基　　金：四川省卫生健康委员会科研课题(19ZD009)。

摘　　要：目的 分析硬膜外阻滞复合全身麻醉在宫颈癌腹腔镜子宫切除术中的应用效果及对疼痛、应激指标的影响。方法 选取2018年2月—2021年4月收治宫颈癌行腹腔镜子宫切除术者122例,按麻醉方式不同分为A组(全身麻醉)60例和B组(硬膜外阻滞复合全身麻醉)62例。对比2组麻醉效果、麻醉相关时间、疼痛情况、平均动脉压(MAP)、心率、去甲肾上腺素(NE)、肾上腺素(E)及不良反应发生情况。结果 B组麻醉效果优于A组(P<0.05)。B组恢复自主呼吸、拔管、苏醒时间均短于A组,视觉模拟评分法评分低于A组(P<0.01)。2组气腹后MAP、心率、NE、E水平均较麻醉前升高,但B组低于A组(P<0.05,P<0.01);术毕时,B组MAP、心率、NE、E水平低于A组(P<0.01)。B组不良反应发生率(4.84%,3/62)低于A组(16.67%,10/60)(P<0.05)。结论 硬膜外阻滞复合全身麻醉在宫颈癌腹腔镜子宫切除术中的应用效果显著,可缓解疼痛,减轻术后应激反应,且安全性高。Objective To analyze the application effect of epidural block combined with general anesthesia in laparoscopic hysterectomy for cervical cancer and its effects on pain and stress indexes.Methods A total of 122 patients who underwent laparoscopic hysterectomy for cervical cancer from February 2018 to April 2021 were selected and divided into group A(receiving general anesthesia,n=60)and group B(receiving epidural block+general anesthesia,n=62)according to different anesthesia methods.Anesthetic effect,anesthesia related time,pain,mean arterial pressure(MAP),heart rate(HR),norepinephrine(NE),epinephrine(E)and adverse reactions were compared between the two groups.Results The anesthetic effect of group B was higher than that of group A(P<0.05).The recovery time of spontaneous breathing,extubation and recovery time of group B were shorter than those of group A,and the visual analog scale(VAS)score of group B was lower than that of group A(P<0.01).After pneumoperitoneum,the levels of MAP,HR,NE and E in the two groups were higher than those before anesthesia,but lower in group B than in group A(P<0.05,P<0.01).After the operation,the MAP,HR,NE and E levels in group B were lower than those in group A(P<0.01).The incidence of adverse reactions in group B was lower than that in group A[(4.84%,3/62)vs.(16.67%,10/60)](P<0.05).Conclusion Epidural block combined with general anesthesia in laparoscopic hysterectomy for cervical cancer has a significant effect,which can relieve pain,and reduce postoperative stress reaction,showing good safety.

关 键 词：宫颈肿瘤 麻醉 硬膜外 全身麻醉 腹腔镜 子宫切除术 疼痛 去甲肾上腺素 肾上腺素 

分 类 号：R737.33[医药卫生—肿瘤]