经阴分娩史对非插管静脉全麻下宫腔镜手术患者术中血流动力学及术后恢复情况的影响

 目的 探讨经阴分娩史对非插管静脉全麻下宫腔镜手术麻醉术中血流动力学及术后恢复情况的影响。方法 检索解放军总医院第一医学中心麻醉临床信息系统,选取2008-08至2019-12在解放军第一医学中心498例行非插管静脉全麻下宫腔镜手术患者围手术期数据,将患者分为有经阴分娩史组(VD组)和无经阴分娩史组(NVD组),应用倾向性评分匹配(PSM),对两组患者的基线情况进行1∶1配对。对比麻醉前(T₁)、麻醉后1 min(T₂)、手术开始时(T₃)以及手术开始后5 min(T₄)的收缩压、舒张压、平均动脉压及心率变化情况;对比两组患者术后随访疼痛NRS评分及恶心呕吐等不适症状的发生率。结果 应用PSM后共354例(NVD组和VD组各177例)纳入分析。T₁与T₂时点两组患者收缩压、舒张压、心率变化未见明显差异;T₃与T₄时点NVD组较VD组收缩压、舒张压、平均动脉压、心率升高(P<0.01);两组SpO₂在T₃时点未见差异,而在T₄时点NVD组SpO₂降低;两组手术时间未见差异;VD组患者术后苏醒时间及离院时间短于NVD组(P<0.01),术后疼痛NRS评分及术后恶心呕吐等不适发生率均低于NVD组(P<0.01)。结论 经阴分娩史对非插管静脉全麻下宫腔镜手术中患者术中血流动力学及术后恢复质量有影响,提示针对患者是否有经阴分娩史应个性化调整麻醉管理方案和用药策略。

Influence of vaginal delivery history on intraoperative hemodynamics and postoperative recovery in patients treated with hysteroscopic surgery under intravenous general anesthesia without tracheal intubation

Objective To evaluate the influence of vaginal delivery history on the intraoperative hemodynamics and postoperative recovery in patients treated with hysteroscopic surgery under intravenous general anesthesia without tracheal intubation.Methods Four hundred and ninety-eight patients admitted into the First Medical Center of PLA General Hospital who were treated with hysteroscopic surgery under intravenous general anesthesia without tracheal intubation were divided into vaginal delivery history group (VD group) and no vaginal delivery history group (NVD group). The baseline conditions of the two groups were matched by propensity score. The changes of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP) and heart rate (HR) before anesthesia (T₁), 1 minute after anesthesia (T₂), the beginning of operation (T₃) and 5 minutes after operation (T₄) between the two groups were compared, and the postoperative pain NRS score, nausea and vomiting were also compared.Results After propensity score matching, 354 patients (177 in NVD group and 177 in VD group) were enrolled in the analysis. There was no significant difference in SBP, DBP, MAP and HR between the two groups at T₁ and T₂ time points. At T₃ and T₄ time points, NVD group showed increased SBP, DBP, MAP and HR than those in VD group (P<0.01). There was no differences in SpO₂ between the two groups at T₃, while the SpO₂ was lower in NVD group at T₄. The surgery time didn’t show differences. VD group patients showed shorter postoperative awake time and hospital departure time (P<0.01), lower postoperative pain NRS score (P<0.01), and lower incidence of postoperative nausea and vomiting (P<0.01).Conclusion The history of vaginal delivery has an impact on the intraoperative hemodynamics and postoperative recovery quality in patients treated with hysteroscopic surgery under intravenous general anesthesia without tracheal intubation, which suggests that the anesthesia management protocols and medication strategy should be individually adjusted for patients with or without a history of vaginal delivery.