腹腔镜子宫肌瘤切除术全麻复合硬膜外麻醉效果及对预后影响  

Effect of general anesthesia combined with epidural anesthesia used in laparoscopic myomectomy and its influence on the prognosis

作　　者：焦俊萍 谢瑞 张春荣 赵金英 JIAO Junping;XIE Rui;ZHANG Chunrong;ZHAO Jinying(Shunyi Hospital,Beijing Hospital Traditional Chinese Medicine,Beijing,101300)

机构地区：[1]北京中医医院顺义医院,101300

出　　处：《中国计划生育学杂志》2024年第1期97-101,共5页Chinese Journal of Family Planning

基　　金：北京市属医院科研培育计划项目(PZ2023024)。

摘　　要：目的:探究腹腔镜子宫肌瘤切除术全麻复合硬膜外麻醉对患者纤溶功能指标纤溶酶原激活物抑制剂-1(PAI-1)、组织型纤溶酶原激活剂(t-PA)、D-二聚体(D-D)及预后的影响.方法:随机选取本院2018年3月-2023年3月收治拟行腹腔镜手术的的子宫肌瘤患者96例,分为联合组和单纯组各48例,分别采用全麻复合硬膜外麻醉或静吸复合全麻干预;对比两组麻醉效果,干预前后纤溶功能、血流动力学、性激素及不良反应和预后指标.结果:麻醉后联合组PAI-1(26.52±3.54μg/L)、t-PA(15.67±2.89μg/L)、D-D(155.62±21.47μg/L)水平均低于单纯组(41.32±4.82μg/L、22.39±3.16μg/L、189.41±22.59μg/L),心率、平均动脉压水平低于单纯组,麻醉效果优于单纯组,卵泡刺激素、黄体生成激素水平低于单纯组,雌二醇水平高于单纯组,不良反应发生率(10.4%)低于单纯组(29.2%),月经转归率(95.8%)高于单纯组(81.3%),复发率(4.2%)低于单纯组(16.7%)(均P<0.05).结论:腹腔镜子宫肌瘤切除术中使用全麻复合硬膜外麻醉可改善患者纤溶功能、血流动力学和性激素指标,麻醉效果更优,不良反应降低且预后较好.Objective:To investigate the influence of general anesthesia combined with epidural anesthesia used in lapa-roscopic myomectomy of patients on their plasminogen activator inhibitor 1(PAI-1),tissue Plasminogen activator(t-PA),D-dimer(D-D)and prognosis.Methods:96 patients with uterine fibroids who wanted laparoscopic myomectomy were randomly selected and were divided into two groups(48 cases in each group)from March 2018 to March 2023.The patients in the control group were given simple general anesthesia,and the patients in the study group were given general anesthesia combined with epidural anesthesia.The anesthetic efect,and the fibrinolysis function,the hemody-namics and the sex hormones levels before and after intervention,and the adverse reactions rate and the prognostic indicators of the patients were compared between the two groups.Results:The levels of PA-1(26.52±3.54μg/L),t+PA(15.67±2.89μg/L).and D-D(155.62±21.47pg/L)of the patients in the study group after anesthesia were significantly lower than those(41.32±4.82μg/L,22.39±3.16pg/L,and 189.41±22.59μg/L)of the patients in the control group.The values of heart rate and mean arterial Pressure,and the levels of follicle-stimulating hormone and luteini-zing hormone of the patients in the study group were significantly lower than those of the patients in the control group..The incidence of adverse reactions(10.4%)and the recurrence rate(4.2%)of the patients in the study group were significantly lower than those(29.2%and 16.7%)of the patients in the control group.The anesthesia efect of the patients in the study group was significantly better than that of the patients in the control group.The menstruation recovery rate(95.8%)of the patients in the study group was significantly higher than that(81.3%)of the patients in the control group(all P<0.05).Conclusion:The general anesthesia combined with epidural anesthesia used in laparoscopic myomectomy of the patients can improve their fibrinolytic function,hemodynamic indexes and scx hormone indexes.and whic

关 键 词：腹腔镜子宫肌瘤切除术 全麻复合硬膜外麻醉 纤溶酶原激活物抑制剂-1 组织型纤溶酶原激活剂 D-二聚体 麻醉效果 性激素 

分 类 号：R614[医药卫生—麻醉学] R737.33[医药卫生—外科学]