探究全身麻醉联合硬膜外麻醉与单纯全身麻醉对妇科腹腔镜手术的麻

探究全身麻醉联合硬膜外麻醉与单纯全身麻醉对妇科腹腔镜手术的麻醉效果比较

发表时间：2018-05-30T10:18:53.147Z 来源：《健康世界》2018年6期作者：张春玲[导读] 对比分析全身麻醉联合硬膜外麻醉与单纯全身麻醉对妇科腹腔镜手术的麻醉效果

张春玲

勃利县人民医院 154500

摘要：目的对比分析全身麻醉联合硬膜外麻醉与单纯全身麻醉对妇科腹腔镜手术的麻醉效果。方法此次研究的对象是选择2017年1～6月在我院妇科采取腹腔镜手术治疗的患者108例，将其临床资料进行回顾性分析，并随机分为观察组和对照组，每组各54例。观察组患者行全身麻醉联合硬膜外麻醉，对照组患者行单纯全身麻醉。分别对两组患者的血流动力学变化情况，子宫松弛程度及临床指标改善情况进行对比分析。结果①两组患者麻醉诱导前后心率、收缩压、舒张压等血流动力学指标比较，差异均无统计学意义（P > 0.05）；观察组患者在建立气腹后、手术结束时、气管插管拔管时的心率、收缩压、舒张压等血流动力学指标均明显低于对照组，差异有统计学意义（P < 0.05）。两组不同时间点心率、收缩压、舒张压组内比较，差异均无统计学意义（P > 0.05）。②观察组患者子宫松弛程度为优者44例（81.5%），良8例（14.8%），差2例（3.7%），对照组患者子宫松弛程度为优者33例（61.1%），良9例（16.7%），差12例（22.2%）。观察组患者子宫松弛程度为优的比例明显高于对照组，观察组患者子宫松弛程度为差的比例明显低于对照组，差异均有统计学意义（P < 0.05）。③观察组患者手术时间为（89.81±10.37）min，麻醉苏醒时间为（6.07±2.29）min；对照组患者手术时间为（110.47±15.56）min，麻醉苏醒时间为（10.14±4.41）min。观察组患者手术时间及苏醒时间均明显短于对照组，差异有统计学意义（P < 0.05）。结论全身麻醉联合硬膜外麻醉的临床麻醉效果要远远优于单纯全身麻醉，可作为较为理想的麻醉方案在临床应用及推广。关键词：单纯全身麻醉；全身麻醉联合硬膜外麻醉；妇科；腹腔镜手术 Objective to compare the effects of general anesthesia combined with epidural anesthesia and simple general anesthesia on gynecological laparoscopic surgery. Methods the object of this study is to select 108 patients who underwent laparoscopic surgery in our hospital in 1~6 2017. The clinical data were retrospectively analyzed，and they were randomly divided into the observation group and the control group，54 cases in each group. The patients in the observation group were treated with general anesthesia combined with epidural anesthesia，and the patients in the control group were treated with simple general anesthesia. The hemodynamic changes of the two groups of patients，the degree of uterine relaxation and the improvement of clinical indexes were compared and analyzed. The results of the two groups of patients before and after anesthesia induction，heart rate，systolic blood pressure and diastolic blood pressure，hemodynamic index comparison，there were no significant differences（P > 0.05）；patients in the observation group at the end of surgery after establishing pneumoperitoneum and extubation time，heart rate，systolic blood pressure，diastolic blood pressure and hemodynamic indexes were obviously lower than those of the control group，the difference was statistically significant（P < 0.05）. There was no statistically significant difference between the two groups（P > 0.05）at the rate of dessert，systolic and diastolic pressure at different time. The observation group of patients with uterine relaxation was excellent in 44 cases（81.5%），good in 8 cases （14.8%），2 cases（3.7%），the control group of patients with uterine relaxation was excellent in 33 cases（61.1%），good in 9 cases（16.7%），12 cases（22.2%）. The proportion of uterine relaxation degree in the observation group was significantly higher than that in the control group. The proportion of the uterine relaxation degree in the observation group was significantly lower than that in the control group，the difference was statistically significant（P < 0.05）.（3）the operative time in the observation group was（89.81 + 10.37）min，and the time for recovery from anesthesia was（6.07 + 2.29）min. The operative time in the control group was（110.47 + 15.56）min，and the time for recovery from anesthesia was（10.14 + 4.41）min. The operative time and the awakening time of the patients in the observation group were significantly shorter than those in the control group，and the difference was statistically significant （P < 0.05）. Conclusion general anesthesia combined with epidural anesthesia is far better than general anesthesia. It can be used as an ideal anesthesia program for clinical application and promotion. [Key words] simple general anesthesia；general anesthesia combined with epidural anesthesia；Gynecologic；laparoscopic surgery

腹腔镜手术因为其对患者创伤性较小、手术过程中的出血量较少、术后患者恢复快等诸多优点及特点赢得了一线众多医疗工作者及广大患者的充分认同，其广泛地应用于包括妇科在内的临床各科室疾病的诊疗工作之中[1]。患者麻醉方式的选择和确定对于手术治疗的成功与否往往具有举足轻重的作用，再加上腹腔镜手术对患者的手术体位有着特殊要求以及建立二氧化碳气腹给患者带来的一系列的生理状态改变，使妇科腹腔镜手术患者在麻醉方式的临床选择上存有一定的争议[2]。本研究通过比较单纯采取全身麻醉与采用全身联合硬膜外麻醉方式在妇科腹腔镜手术患者中的临床应用价值，积极探讨最大限度地提高妇科腹腔镜手术患者的麻醉效果，现将研究结果报道如下：1 资料与方法

1.1 一般资料

选择2017年1～6月在我院妇科采取腹腔镜方式进行手术治疗的患者108例为研究对象，均为女性，年龄25～56岁，平均（35.7±7.5）岁，体重44～80 kg，平均（60.3±10.1）kg。所有入选的患者均具有采取腹腔镜手术的临床指征，患者的“美国麻醉医师协会”（ASA）分级Ⅰ～Ⅱ级，其中Ⅰ级57例，Ⅱ级51例。排除患有心、肺、肝、肾等全身重要器官功能不全或衰竭者，有高血压、内分泌疾病等合并症者，研究过程中使用的相关药物过敏史及禁忌证者。手术方式包括卵巢囊肿或卵巢畸胎瘤剥除术55例，子宫肌瘤挖除术20例，全子宫切除术22例，其他术式11例。采用随机数字表法将人选的患者分为对照组和观察组，每组患者各54例。观察组患者年龄25～55岁，平均（34.6±6.1）岁，体重44～79 kg，平均（61.2±11.5）kg，ASAⅠ级29例，Ⅱ级25例；对照组患者年龄26～56岁，平均（36.1±7.9）岁，体重45～80 kg，平均（59.7±9.6）kg，ASAⅠ级28例，Ⅱ级26例。两组患者的年龄、体重、ASA分级等临床一般资料比较，差异均无统计学意义（P > 0.05），具有可比性。