腹腔镜联合输尿管镜治疗肝胆管结石的全麻管理效果分析
|
摘要
目的分析全麻管理在腹腔镜联合输尿管镜治疗肝胆管结石中的应用效果。方法选取2015年1月—2016年12月未开展全麻管理前行腹腔镜联合输尿管镜治疗的40例肝胆管结石患者作为对照组;将2017年1月—2018年2月开展麻醉管理后收治的腹腔镜联合输尿管镜治疗患者40例作为观察组,统计全麻管理实施前后一般手术情况、平均动脉压、心率、脉搏血氧饱和度、术后疼痛、住院时间及费用、并发症发生率。结果两组手术时间、术中补液及输血量总和、术中出血、术中尿量比较无统计学差异(P>0.05);但观察组麻醉拔管时间较对照组短(P<0.05);两组患者入室、建立气腹前、气腹建立后、术毕清醒时其平均动脉压、心率、脉搏血氧饱和度等生理检测指标经方差分析差异虽无统计学意义(P>0.05),但对照组各时间点上述指标水平波动幅度仍较观察组明显;同时,两组进入手术室及建立气腹时鼻咽温度虽比较无统计学差异,但对照组气腹建立后、术毕鼻咽温度均较入室时有明显降低(P<0.05),并低于观察组;观察组住院时间及住院费用均较对照组少,术后胆心反射、低温、肝肾功能异常等不良并发症发生率(10.00%)均低于对照组(30.00%),差异有统计学意义(P<0.05)。结论于肝胆管结石患者,腹腔镜联合输尿管镜治疗时实施全麻管理或能缩短麻醉拔管时间,维持更稳定的肌体中心温度,降低术后并发症风险,更利于术后康复。
Objective To analyze the effects of general anesthesia management in the treatment of hepatolithiasis with laparoscope combined with ureteroscope. Methods A total of 40 patients with hepatolithiasis treated by laparoscope combined with ureteroscope in the hospital before general anesthesia management from January 2015 to December 2016 were selected as the control group. Another 40 patients treated after general anesthesia management from January 2017 to February2018 were selected as the observation group. The general situation of surgery before and after general anesthesia management,mean arterial pressure,heart rate,pulse oxygen saturation,postoperative pain,hospital stay,hospitalization expenses and incidence of complications were statistically analyzed. Results There was no significant difference between the two groups in the surgical time,the sum of intraoperative fluid infusion and blood transfusion volume,intraoperative blood loss or intraoperative urine volume( P > 0. 05),but the extubation time of observation group was shorter than that of the control group( P <0. 05). There were no statistically significant differences in physiological indicators such as mean arterial pressure,heart rate and pulse oxygen saturation in the two groups at the time of entering the room,before and after establishment of pneumoperitoneum and awaking after surgery( P > 0. 05). However,the changes of above indicators in the control group at different time points were significantly greater than those in the observation group. There was no difference in the nasopharyngeal temperature between the two groups at the time of entering the operating room and establishment of pneumoperitoneum. The nasopharyngeal temperature of control group after establishment of pneumoperitoneum and at the end of surgery was significantly lower than that at the time of entering the room( P < 0. 05),and was lower than that of the observation group. The hospital stay and hospitalization costs of the observation group were less than those of the control group. The incidence of postoperative adverse reactions such as biliary-cardiac reflex reflex,hypothermia and abnormal liver and kidney function in the observation group( 10. 00%) was lower than that in the control group( 30. 00%)( P < 0. 05). Conclusion The application of general anesthesia management in the treatment of hepatolithiasis with laparoscope combined with ureteroscope can shorten the extubation time,maintain stable body temperature,and reduce the risk of postoperative complications,which is more conducive to postoperative recovery.
Objective To analyze the effects of general anesthesia management in the treatment of hepatolithiasis with laparoscope combined with ureteroscope. Methods A total of 40 patients with hepatolithiasis treated by laparoscope combined with ureteroscope in the hospital before general anesthesia management from January 2015 to December 2016 were selected as the control group. Another 40 patients treated after general anesthesia management from January 2017 to February2018 were selected as the observation group. The general situation of surgery before and after general anesthesia management,mean arterial pressure,heart rate,pulse oxygen saturation,postoperative pain,hospital stay,hospitalization expenses and incidence of complications were statistically analyzed. Results There was no significant difference between the two groups in the surgical time,the sum of intraoperative fluid infusion and blood transfusion volume,intraoperative blood loss or intraoperative urine volume( P > 0. 05),but the extubation time of observation group was shorter than that of the control group( P <0. 05). There were no statistically significant differences in physiological indicators such as mean arterial pressure,heart rate and pulse oxygen saturation in the two groups at the time of entering the room,before and after establishment of pneumoperitoneum and awaking after surgery( P > 0. 05). However,the changes of above indicators in the control group at different time points were significantly greater than those in the observation group. There was no difference in the nasopharyngeal temperature between the two groups at the time of entering the operating room and establishment of pneumoperitoneum. The nasopharyngeal temperature of control group after establishment of pneumoperitoneum and at the end of surgery was significantly lower than that at the time of entering the room( P < 0. 05),and was lower than that of the observation group. The hospital stay and hospitalization costs of the observation group were less than those of the control group. The incidence of postoperative adverse reactions such as biliary-cardiac reflex reflex,hypothermia and abnormal liver and kidney function in the observation group( 10. 00%) was lower than that in the control group( 30. 00%)( P < 0. 05). Conclusion The application of general anesthesia management in the treatment of hepatolithiasis with laparoscope combined with ureteroscope can shorten the extubation time,maintain stable body temperature,and reduce the risk of postoperative complications,which is more conducive to postoperative recovery.
引文
[1]张超城,肖晓山.纳美芬对全麻腹腔镜手术拮抗呼吸抑制和超前镇痛的临床效果[J].现代医院,2016,16(2):188-190.
[2]刘悦,王志明,韩婷婷,等.胆心反射导致心跳骤停患者行胆囊切除术一例[J].临床麻醉学杂志,2015,31(9):933-933.
[3]卢先卿,张建华,梁健群,等.右美托咪啶联合双管喉罩对腹腔镜胆囊切除术全麻效果的影响[J].现代医院,2017,17(3):425-427.
[4]李成学,杨凯,张虹.梗阻性黄疸介入治疗中胆心反射的防治[J].中国介入影像与治疗学,2017,14(5):283-286.
[5]张建军.输尿管硬镜气压弹道碎石与胆道镜下液电碎石术治疗肝内外胆管结石的疗效比较[J].海南医学,2015,26(7):1039-1041.
[6]马鹏涛,牛文超,巩燕,等.术中低体温对全身麻醉腹腔镜手术患者术后认知功能的影响[J].护理学报,2016,23(14):56-59.
[7]陶玉娟.舒芬太尼、芬太尼用于老年腹腔镜全麻手术麻醉效果比较[J].山东医药,2016,56(36):95-97.
[8]杨智慧,朱述侠,叶丽,等.预热输液对全麻下腹腔镜手术患者复苏效果的影响[J].广东医学,2017,38(8):1249-1252.
[9]刘婧,宋家志,饶琳.新斯的明对全麻下行腹腔镜胆囊切除术恢复期患者术后认知状态及胃肠功能恢复的影响[J].河北医药,2016,38(9):1357-1359.
[10]庞刚,张勇.全身麻醉联合硬膜外麻醉在老年高血压患者腹腔镜胆囊切除术中的应用[J].实用肝脏病杂志,2015,18(4):403-406.
[11]李九红,张月凌,马长龙,等.全身麻醉联合硬膜外麻醉和全身麻醉对腹腔镜胆囊切除术中的高血压老年患者的临床疗效[J].山西医药杂志,2017,46(10):1215-1217.
[12]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]刘悦,王志明,韩婷婷,等.胆心反射导致心跳骤停患者行胆囊切除术一例[J].临床麻醉学杂志,2015,31(9):933-933.
[3]卢先卿,张建华,梁健群,等.右美托咪啶联合双管喉罩对腹腔镜胆囊切除术全麻效果的影响[J].现代医院,2017,17(3):425-427.
[4]李成学,杨凯,张虹.梗阻性黄疸介入治疗中胆心反射的防治[J].中国介入影像与治疗学,2017,14(5):283-286.
[5]张建军.输尿管硬镜气压弹道碎石与胆道镜下液电碎石术治疗肝内外胆管结石的疗效比较[J].海南医学,2015,26(7):1039-1041.
[6]马鹏涛,牛文超,巩燕,等.术中低体温对全身麻醉腹腔镜手术患者术后认知功能的影响[J].护理学报,2016,23(14):56-59.
[7]陶玉娟.舒芬太尼、芬太尼用于老年腹腔镜全麻手术麻醉效果比较[J].山东医药,2016,56(36):95-97.
[8]杨智慧,朱述侠,叶丽,等.预热输液对全麻下腹腔镜手术患者复苏效果的影响[J].广东医学,2017,38(8):1249-1252.
[9]刘婧,宋家志,饶琳.新斯的明对全麻下行腹腔镜胆囊切除术恢复期患者术后认知状态及胃肠功能恢复的影响[J].河北医药,2016,38(9):1357-1359.
[10]庞刚,张勇.全身麻醉联合硬膜外麻醉在老年高血压患者腹腔镜胆囊切除术中的应用[J].实用肝脏病杂志,2015,18(4):403-406.
[11]李九红,张月凌,马长龙,等.全身麻醉联合硬膜外麻醉和全身麻醉对腹腔镜胆囊切除术中的高血压老年患者的临床疗效[J].山西医药杂志,2017,46(10):1215-1217.
[12]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.