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

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、P ET CO 2、SpO 2、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SpO2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P ET CO 2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 an-esthesia,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,P ET CO 2 , SpO 2 , NE and E at T0、T1、T2 and T3(P>0. 05). In the control group,there was no significant difference in SpO2 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 af-ter 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 laparoscop-ic surgery,spinal anesthesia combined with epidural anesthesia has less effect on blood pressure,respiratory and circulatory func-tion and stress response level,and it is more safety.