不同麻醉方案对妇科腹腔镜手术的麻醉效果及对患者呼吸循环功能、GLU、NE水平的影响
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摘要
目的分析不同麻醉方案对妇科腹腔镜手术患者呼吸循环功能、血糖(GLU)、去甲肾上腺素(NE)水平影响及麻醉效果。方法选取2014年2月至2016年7月在我院进行妇科腹腔镜手术患者90例,采用随机数字法分为对照组和观察组。对照组患者采用全身麻醉,观察组患者采用腰麻联合硬膜外麻醉。观察两组麻醉方案效果及患者呼吸循环功能、子宫松弛程度情况及应激因子水平变化情况。结果观察组患者T0、T1、T2及T3时MAP、Paw、PETCO2、Sp O2、NE及E水平比较差异无统计学意义(P>0.05)。对照组患者不同时间点Sp O2水平比较差异无统计学意义(P>0.05)。两组患者T1和T2时GLU水平均较T0时升高,观察组患者GLU水平低于同时间点对照组,差异有统计学意义(P<0.05)。对照组患者T1、T2时MAP、Paw及PETCO2水平、T2时NE水平及T2、T3时E水平均高于本组T0和同时间点观察组,差异有统计学意义(P<0.05)。观察组患者麻醉后子宫松弛度优于对照组,差异有统计学意义(P<0.05)。观察组患者完全苏醒时间、自主呼吸恢复时间及住院时间均短于对照组,肺部感染、恶心呕吐及声音沙哑发生率均少于对照组,差异有统计学意义(P<0.05)。结论腰麻联合硬膜外麻醉相较于全身麻醉在妇科腹腔镜手术中对患者血压、呼吸循环功能、应激反应水平影响较小,且安全性较高。
Objective To analyze the effects of different anesthetic schemes on respiratory and circulatory function,blood glucose( GLU) level,norepinephrine( NE) and anesthetic effect in patients undergoing gynecologic laparoscopic surgery.Methods From February 2014 to July 2016,90 patients undergoing gynecologic laparoscopic surgery in our hospital were selected and divided into control group and observation group by random number method.The patients in the control group were treated with general anesthesia,while the patients in the observation group were given spinal anesthesia combined with epidural anesthesia. The effect of anesthesia and the changes of respiratory and circulatory function,uterine relaxation and stress factors levels of the two groups were observed.Results In the observation group,there was no significant difference in the levels of MAP,Paw,PETCO2,Sp O2,NE and E at T0、T1、T2 and T3( P>0. 05).In the control group,there was no significant difference in Sp O2 levels at different time points( P>0. 05).The levels of GLU at T1 and T2 in the two groups were higher than those at T0,and the GLU level in the observation group was lower than that in the control group at the same time point,statistically significant( P < 0. 05). The levels of MAP,Paw and PETCO2 at T1 and T2,the NE level at T2 and the E level at T2 and T3 in the control group were higher than those in the same group at T0 and in observation group at the same time point,statistically significant( P<0. 05).The degree of uterine relaxation after anesthesia in the observation group was better than that in the control group,statistically significant( P<0. 05).The time of full recovery,the time of self recovery and the time of hospitalization in the observation group were all shorter than those in the control group,and the incidence of pulmonary infection,nausea,vomiting and hoarseness in the observation group was lower than those in the control group,statistically significant( P<0. 05).Conclusion Compared with general anesthesia,in gynecological laparoscopic surgery,spinal anesthesia combined with epidural anesthesia has less effect on blood pressure,respiratory and circulatory functionand stress response level,and it is more safety.
Objective To analyze the effects of different anesthetic schemes on respiratory and circulatory function,blood glucose( GLU) level,norepinephrine( NE) and anesthetic effect in patients undergoing gynecologic laparoscopic surgery.Methods From February 2014 to July 2016,90 patients undergoing gynecologic laparoscopic surgery in our hospital were selected and divided into control group and observation group by random number method.The patients in the control group were treated with general anesthesia,while the patients in the observation group were given spinal anesthesia combined with epidural anesthesia. The effect of anesthesia and the changes of respiratory and circulatory function,uterine relaxation and stress factors levels of the two groups were observed.Results In the observation group,there was no significant difference in the levels of MAP,Paw,PETCO2,Sp O2,NE and E at T0、T1、T2 and T3( P>0. 05).In the control group,there was no significant difference in Sp O2 levels at different time points( P>0. 05).The levels of GLU at T1 and T2 in the two groups were higher than those at T0,and the GLU level in the observation group was lower than that in the control group at the same time point,statistically significant( P < 0. 05). The levels of MAP,Paw and PETCO2 at T1 and T2,the NE level at T2 and the E level at T2 and T3 in the control group were higher than those in the same group at T0 and in observation group at the same time point,statistically significant( P<0. 05).The degree of uterine relaxation after anesthesia in the observation group was better than that in the control group,statistically significant( P<0. 05).The time of full recovery,the time of self recovery and the time of hospitalization in the observation group were all shorter than those in the control group,and the incidence of pulmonary infection,nausea,vomiting and hoarseness in the observation group was lower than those in the control group,statistically significant( P<0. 05).Conclusion Compared with general anesthesia,in gynecological laparoscopic surgery,spinal anesthesia combined with epidural anesthesia has less effect on blood pressure,respiratory and circulatory functionand stress response level,and it is more safety.
引文
[1]赵海艳,陈长香,王丹.妇科腹腔镜手术患者术后症状对舒适度的影响[J].中国煤炭工业医学杂志,2015,18(7):1213-1215.
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[9]安玉明,孙轶娜.基于应激反应及血流动力学变化观察不同麻醉方法在妇科腹腔镜手术中的应用[J].检验医学与临床,2017,14(5):670-672.
[10]任应娜,苏利伟,杨海龙.不同剂量地佐辛对妇科腹腔镜手术患者术后苏醒期镇痛效果的研究[J].实用临床医药杂志,2016,20(21):155-156.
[11]程伟,刘修恒,陈明.腹腔镜与开放肾癌根治术对机体应激反应影响的比较[J].微创泌尿外科杂志,2016,5(2):77-79.
[12]姚帆,张宗泽,李才顺.三种不同麻醉方式对产妇血流动力学及新生儿的影响[J].现代生物医学进展,2016,16(14):2679-2682.
[13]罗中兵,张燕辉,宋晓阳.联合腰麻硬膜外麻醉或全凭静脉麻醉用于经皮肾镜碎石术[J].重庆医学,2015,44(2):251-253.
[14]李正凯,冯玉,郭冠军.不同麻醉方式对感染性休克患者处理效果分析[J].中华医院感染学杂志,2016,26(6):1253-1255.
[15]伦明辉,孙晓峰,赵宏.不同麻醉方法对下腹部腹腔镜手术应激影响的对照研究[J].河北医药,2015,37(24):3688-3691.
[2]刘芳,谢建端,田芸.腹腔镜与开腹手术治疗妇科疾病的临床效果对比[J].中国内镜杂志,2016,22(09):57-60.
[3]Narducci F,Lambaudie E,Mautone D.Extraperitoneal Para-aortic Lymphadenectomy by Robot-Assisted Laparoscopy in Gynecologic Oncology:Preliminary Experience and Advantages and Limitations.[J].International Journal of Gynecological Cancer Official Journal of the International Gynecological Cancer Society,2015,25(8):1494-502.
[4]毕艳,李涓,侯正友.两种麻醉方式对腹腔镜胃癌根治术CO2气腹对患者血气及应激水平的影响[J].标记免疫分析与临床,2015,22(11):1104-1106.
[5]Hadade A,Ionescu D,Mocan T.Total Intravenous Versus Inhalation Anesthesia in Patients Undergoing Laparoscopic Cholecystectomies.Effects on Two Proinflammatory Cytokines Serum Levels:Il-32 and TNF-Alfa.[J].Journal of Critical Care Medicine,2016,2(1):44-50.
[6]张文东,许艳春.妇科腹腔镜手术麻醉方式选择对患者循环及应激反应的影响[J].海南医学院学报,2016,22(23):2915-2917.
[7]Shukla A,Misra S.Ease of intubation:A randomized,double-blind study to compare two doses of rocuronium bromide for endotracheal intubation[J].Anesthesia Essays&Researches,2016,10(3):512-515.
[8]Fawzi H,Samir G.Induction of anesthesia and endotracheal intubation in children without muscle relaxant:a comparative study on addition of fentanyl or propofol to sevoflurane[J].2016,9(1):39-43.
[9]安玉明,孙轶娜.基于应激反应及血流动力学变化观察不同麻醉方法在妇科腹腔镜手术中的应用[J].检验医学与临床,2017,14(5):670-672.
[10]任应娜,苏利伟,杨海龙.不同剂量地佐辛对妇科腹腔镜手术患者术后苏醒期镇痛效果的研究[J].实用临床医药杂志,2016,20(21):155-156.
[11]程伟,刘修恒,陈明.腹腔镜与开放肾癌根治术对机体应激反应影响的比较[J].微创泌尿外科杂志,2016,5(2):77-79.
[12]姚帆,张宗泽,李才顺.三种不同麻醉方式对产妇血流动力学及新生儿的影响[J].现代生物医学进展,2016,16(14):2679-2682.
[13]罗中兵,张燕辉,宋晓阳.联合腰麻硬膜外麻醉或全凭静脉麻醉用于经皮肾镜碎石术[J].重庆医学,2015,44(2):251-253.
[14]李正凯,冯玉,郭冠军.不同麻醉方式对感染性休克患者处理效果分析[J].中华医院感染学杂志,2016,26(6):1253-1255.
[15]伦明辉,孙晓峰,赵宏.不同麻醉方法对下腹部腹腔镜手术应激影响的对照研究[J].河北医药,2015,37(24):3688-3691.