全身麻醉或复合连续硬脊膜外阻滞麻醉在高血压患者腹腔镜全子宫切除术中的麻醉效果对比研究

Comparative study of general anesthesia combined with epidural anesthesia and single anesthesia for hypertensive patients with laparoscopic hysterectomy

摘要:

目的 研究全身麻醉复合硬膜外麻醉GAEA与单纯全身麻醉SA在高血压患者腹腔镜全子宫切除术TLH中的麻醉效果。方法 选择2012年7月~2013年7月在该院治疗的TLH患者86例，以数字法随机分成GAEA组（43例）和SA组（43例）。分别对GAEA组实施GAEA方案，SA组实施SA方案麻醉。对比两组心率、收缩压以及舒张压变化水平，术中子宫牵拉反应抑制情况，两组患者麻醉恢复情况，两组麻醉药物使用情况。结果 GAEA组对子宫牵拉反应抑制有效率为90.7%；SA组抑制有效率为86.0%，两组对子宫牵拉反应抑制有效率比较无统计学差异（P >0.05）。两组在T0和T1时的心率、收缩压、舒张压相比，差异均无统计学意义（均P >0.05）。但GAEA组在T2和T3时的心率、收缩压、舒张压为均显著低于SA组，差异均有统计学意义（均P <0.05）。GAEA组的自主呼吸的恢复时长、拔管时长以及完全清醒的时长均显著少于SA组，差异均有统计学意义（均P <0.05）。GAEA组的芬太尼、七氟烷以及丙泊酚的用药量均显著少于SA组，差异均有统计学意义（均P <0.05）。结论 GAEA方案在高血压患者TLH中的麻醉效果相对更佳，应将其作为首选麻醉方案。

Abstract:

【Objective】 To study anesthetic effect of general anesthesia combined with epidural anesthesia (GAEA) and single anesthesia (SA) for hypertensive patients with laparoscopic hysterectomy. 【Methods】 Selected 86 cases of TLH patients from July 2012 to July 2013 in our hospital were randomly divided into GAEA group (43 cases) and SA group (43 cases). GAEA group was treated with respectively GAEA program, SA group was treated with SA programs anesthesia. The heart rate, systolic and diastolic blood pressure levels in both groups of patients anesthesia recovery were compared between the two groups . 【Results】 GAEA group uterine stretch response inhibition efficiency was 90.7%; SA group inhibitory rate was 86%, uterus traction response inhibition efficiency had no statistical differences (P>0.05). The heart rate at the time of T0 and T1, systolic blood pressure, diastolic blood pressure, the difference was not statistically significant different (P>0.05). In GAEA group the heart rate, systolic blood pressure, diastolic blood pressure at T2 and T3 were significantly lower than those in the SA group, differences were statistically significant (both P<0.05). Spontaneous breathing GAEA group restored long, long time and fully awake extubation time was significantly longer than the SA group, the differences were statistically significant (P<0.05). Fentanyl GAEA group, sevoflurane and propofol medication were significantly less than the SA group , the differences were statistically significant (P<0.05). 【Conclusion】 GAEA programs anesthesia in patients with hypertension TLH is relatively better, it should be the preferred anesthetic solution.