摘要
目的 探讨全麻复合硬膜外麻醉对全子宫切除术患者镇痛效果及微循环的影响.方法 92例择期行全子宫切除术的患者,通过随机数表法分为观察组(n=46)和对照组(n=46).观察组给予全身麻醉复合硬膜外麻醉,对照组仅给予全身麻醉.比较2组患者手术情况和麻醉前(T0)、气管插管时(T1)、气腹后10min(T2)、术后(T3)、拔管时(T4)血流动力学及应激反应,并比较术后视觉模拟疼痛评分(visual analog pain scores,VAS)评分.结果 2组患者手术时间、补液量差异无统计学意义.对照组在T1、T2、T3时平均动脉压(mean artery pressure,MAP)、心率(heart rate,HR)水平显著增高(P<0.05),观察组在T1、T2、T3时MAP、HR水平均比对照组低(P<0.05),且观察组在T1、T2、T3、T4时皮质醇(Cor)、肾上腺素(E)、去甲肾上腺素(NE)水平均比对照组低(P<0.05);2组患者在术后6、12h时,静止状态和咳嗽状态VAS评分均高于术后1h(P<0.05),但观察组得分均比对照组低(P<0.05).结论 在全子宫切除术中应用全麻复合硬膜外麻醉效果显著,可保持手术过程中血流动力学稳定,减轻应激反应,缓解术后疼痛.
Abstract
Objective To study effect of general anesthesia combined with epidural anesthesia on analgesia and microcirculation in patients undergoing total hysterectomy. Methods 92 patients of total hysterectomy who received therapy were selected, according to random number table,those patients were divided into the observation group (n=42) and the control group (n=48),the observation group received general anesthesia combined with epidural anesthesia, the control group were only given general anesthesia.The operation condition, hemodynamics and stress response before anesthesia(T0), at tracheal intubation(T1), after pneumoperitoneum 10min(T2), after surgery(T3), at extubation(T4) were compared,and postoperative pain (VAS) score was compared. Results There was no significant difference in operation time and fluid volume between the two groups. In the control group,the levels of mean arterial pressure (MAP), heart rate (HR) at the time of T1, T2, T3 were significantly increased(P<0.05), the levels of MAP and HR at the time of T1,T2,T3 in the observation group were lower than the control group(P<0.05). The cortisol (Cor), epinephrine (E), norepinephrine (NE) at the time of T1,T2,T3,T4 in the observation group were lower than the control group(P<0.05). Two groups of patients in the postoperative 12h, 6h, the VAS scores in the resting state and cough state were higher than the postoperative 1h(P<0.05),but the scores in the observation group were lower than the control group(P<0.05). Conclusion General anesthesia combined with epidural anesthesia is well for total hysterectomy,which can maintain hemodynamic stability during surgery, relieve stress reaction, alleviate postoperative pain, it is worthy of application and promotion.
NETL
NSTL
维普
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