不同全身麻醉方式对妇科腔镜全身麻醉苏醒期的影响

目的　对比不同麻醉方式对于妇科腔镜手术患者全身麻醉苏醒期的影响。方法　选取2020年1月至2021年5月在厦门市湖里区妇幼保健院行妇科腔镜手术的患者70例为研究对象进行前瞻性研究。患者年龄20～55岁，实施腔镜手术时间2 h内，美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级。随机数字表法将患者分为观察组和对照组，各35例。观察组全程实施全凭静脉麻醉，对照组在维持阶段实施静吸复合麻醉。全身麻醉苏醒期分别记录患者自主呼吸恢复时间、睁眼时间、气管导管拔出时间及Ramsay镇静评分；记录患者不同时间段血压及心率变化情况；对患者认知情况进行评分；记录患者呛咳、躁动及恶心呕吐等不良反应发生情况。采用χ²检验和独立样本t检验。结果　观察组Ramsay镇静评分（2.78±0.68）分，显著高于对照组的（1.69±0.51）分（t=7.587，P<0.05）；两组不同时间点血流动力学指标差异无统计学意义（均P>0.05）；观察组麻醉后12 h及24 h简易精神状况检查（MMS）评分分别为（27.89±0.41）分及（29.01±0.51）分，显著高于对照组的（25.10±0.38）分及（27.15±0.43）分（t=29.527、16.496，均P<0.05）；观察组呛咳及躁动发生率分别为11.43%（4/35）及8.57%（3/35），显著低于对照组的40.00%（14/35）及31.43%（11/35）（χ²=7.479、5.714，均P<0.05）。结论　2 h内实施妇科腔镜手术全程实施全凭静脉麻醉，不影响其苏醒及拔管时间，不影响血流动力学的稳定性，且对患者认知功能影响小，减少拔管时不良反应发生率的同时提高了全身麻醉苏醒的质量。

Effects of different general anesthesia methods on anesthetic recovery period in patients undergoing gynecological endoscopic surgery

Objective　To compare the effects of different general anesthesia methods on the anesthetic recovery period in patients undergoing gynecological endoscopic surgery. Methods　A prospective study was conducted on 70 patients who underwent gynecological endoscopic surgery in Maternal and Child Health Care Hospital at Huli District from January 2020 to May 2021. They were 20 to 55 years old; the surgery was finished within 2 hours; the patients were classified as American Society of Anesthesiologists (ASA) Grade Ⅰ to Ⅱ. The patients were divided into an observation group and a control group by the random number table method, with 35 cases in each group. The observation group took intravenous anesthesia during the whole course, and the control group took intravenous and inhalation anesthesia during the maintenance stage. The recovery time of spontaneous respiration, the time to open eyes, the time to pull out tracheal tube, and Ramsay sedation score were recorded respectively during the recovery period of general anesthesia. The blood pressures and heart rates in different time periods were recorded. The patients' cognition was scored. The adverse reactions, such as cough, restlessness, and nausea and vomiting, were recorded. χ² and independent-sample t tests were applied. Results　The Ramsay sedation score in the observation group was significantly higher than that in the control group (2.78±0.68) vs. (1.69±0.51); t=7.587, P<0.05]. There were no statistical differences in hemodynamic indicators between the two groups at different time points (all P>0.05). The scores of Mini-Mental State Examination (MMS) 12 and 24 h after anesthesia were (27.89±0.41) and (29.01±0.51) in the observation group, respectively, which were significantly higher than those in the control group (25.10±0.38) and (27.15±0.43)] (t=29.527 and 16.496; both P<0.05). The incidences of cough and restlessness in the observation group were 11.43% (4/35) and 8.57% (3/35), respectively, which were significantly lower than those in the control group 40.00% (14/35) and 31.43% (11/35)] (χ²=7.479 and 5.714, both P<0.05). Conclusion　The application of total intravenous anesthesia in the whole process of gynecological endoscopic surgery within 2 hours does not affect the times of awakening and decannulation and the stability of hemodynamics, and has little impact on the patients' cognitive function, reduces the incidence of adverse reactions during decannulation, and improves the quality of general anesthesia awakening.