| 不同麻醉维持方案对腹腔镜下全子宫切除术患者麻醉效果及血流动力学的影响 |
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| 引用本文： | 吴雅松,傅志海. 不同麻醉维持方案对腹腔镜下全子宫切除术患者麻醉效果及血流动力学的影响[J]. 国际医药卫生导报, 2022, 28(12): 1728-1731. DOI: 10.3760/cma.j.issn.1007-1245.2022.12.023 |
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| 作者姓名： | 吴雅松 傅志海 |
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| 作者单位： | 1厦门市湖里区妇幼保健院麻醉科，厦门 361009；2厦门市第三医院麻醉科，厦门 361100 |
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| 摘 要： | 目的 探究不同麻醉维持对腹腔镜下全子宫切除术患者麻醉效果及血流动力学的影响。方法 选择2016年12月至2019年12月拟于厦门市湖里区妇幼保健院行腹腔镜下全子宫切除术的68例患者，用密封信封法随机分组为对照组（34例）与观察组（34例）。对照组患者年龄（48.73±6.52）岁，产次（2.86±0.58）次；观察组患者年龄（49.24±6.87）岁，产次（2.92±0.63）次。对照组予以瑞芬太尼靶控输注联合间断吸入七氟醚的静吸复合麻醉维持，观察组予以丙泊酚和瑞芬太尼靶控输注的单纯静脉维持麻醉，比较两组患者麻醉效果、血流动力学指标［麻醉诱导前（T0）、麻醉诱导后（T1）、气管插管时（T2）、建立气腹后5 min（T3）、术毕（T4）、拔管时（T5）、拔管后30 min（T6）7个时刻］与不良反应情况。计量资料采用重复测量方差分析或独立样本t检验，计数资料采用χ2检验。结果 相比于对照组，观察组麻醉诱导和术后苏醒、拔管、定向力恢复的时间更短（均P<0.05），观察组术后躁动2例（5.88%），对照组术后躁动10例（29.41%），两组躁动发生率对比差异有统计学意义（P<0.05）；T0~T6时刻，两组患者收缩压、舒张压及心率水平均存在明显波动（均P<0.05），观察组患者T2与T3时刻的收缩压、舒张压及心率水平均显著低于对照组（均P<0.05）；两组患者术后不良反应如恶心呕吐、头晕、嗜睡、心动过缓，观察组发生3例，对照组发生5例，对比差异无统计学意义（P>0.05）。结论 单纯静脉麻醉维持方案在腹腔镜下全子宫切除术中的麻醉效果优于静吸复合麻醉维持方案，且有利于患者血流动力学稳定、降低应激反应发生风险，不良反应较少。
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| 关 键 词： | 腹腔镜下全子宫切除术 静吸复合麻醉 单纯静脉麻醉 麻醉效果 血流动力学 |
| 收稿时间： | 2021-09-08 |
Effects of different anesthesia maintenance regimens on anesthetic effects and hemodynamics in patients undergoing laparoscopic total hysterectomy |
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| Wu Yasong,Fu Zhihai. Effects of different anesthesia maintenance regimens on anesthetic effects and hemodynamics in patients undergoing laparoscopic total hysterectomy[J]. International Medicine & Health Guidance News, 2022, 28(12): 1728-1731. DOI: 10.3760/cma.j.issn.1007-1245.2022.12.023 |
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| Authors: | Wu Yasong Fu Zhihai |
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| Affiliation: | 1 Department of Anesthesiology, Xiamen Huli District Maternity andChild Care Hospital, Xiamen 361009, China;2 Department ofAnesthesiology, The Third Hospital of Xiamen, Xiamen 361100, China |
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| Abstract: | Objective To explore the effects of different anesthesia maintenance regimens onanesthetic effects and hemodynamics in patients undergoing laparoscopic totalhysterectomy. Methods Sixty-eight patientswho were scheduled to undergo laparoscopic total hysterectomy in Xiamen HuliDistrict Maternity and Child Care Hospital from December 2016 to December 2019were selected and were randomly divided into a control group (34 cases) and anobservation group (34 cases) by the sealed envelope method. The control groupwas (48.73±6.52) years old with (2.86±0.58) births, and the observation groupwas (49.24±6.87) years old with (2.92±0.63) births. The control group adoptedintravenous-inhalation combined anesthesia maintenance regimen of remifentaniltarget-controlled infusion and intermittent inhalation of sevoflurane, and theobservation group adopted simple intravenous maintenance anesthesia regimen oftarget-controlled infusion of propofol and remifentanil. The anestheticeffects, hemodynamic indexes before anesthesia induction (T0), afteranesthesia induction (T1), at tracheal intubation (T2), 5min after establishment of pneumoperitoneum (T3), at the end ofsurgery (T4), at extubation (T5), and 30 min afterextubation (T6), and adverse reactions of the two groups werecompared. Repeated-measure ANOVA or independent sample t test was used for the measurement data, and χ2 test was used for the count data. Results The anesthesia induction time, postoperative wake-up time, extubationtime, and recovery time of orientation were shorter and the incidence ofpostoperative agitation [5.88% (2/34) vs. 29.41% (10/34)] was lower in theobservation group compared to those in the control group (all P<0.05). At T0-T6,the systolic blood pressure, diastolic blood pressure, and heart rate in thetwo groups were fluctuated significantly (all P<0.05), and the systolic blood pressure, diastolic bloodpressure, and heart rate in the observation group at T2 and T3 were significantly lower than those in the control group (all P<0.05). In terms of postoperativeadverse reactions such as nausea and vomiting, dizziness, drowsiness, andbradycardia, there were 3 cases in the observation group and 5 cases in thecontrol group, and there was no statistically significant difference betweenthe two groups (P>0.05). Conclusion The anesthetic effectof simple intravenous anesthesia maintenance in laparoscopic total hysterectomyis better than that of intravenous-inhalation combined anesthesia maintenance,and the former regimen is beneficial to hemodynamic stability and reduce therisk of stress response, with fewer adverse reactions. |
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| Keywords: | Laparoscopic total hysterectomy Intravenous-inhalation combined anesthesia Simple intravenous anesthesia Anesthetic effect Hemodynamics |
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