全身麻醉复合硬膜外麻醉对腹腔镜全子宫切除术患者应激反应与纤溶功能的影响

Effects of stress response and fibrinolytic function on laparoscopic hysterectomy with general anesthesia combined with epidural anesthesia

摘要:

目的  分析全身麻醉复合硬膜外麻醉对腹腔镜全子宫切除术患者应激反应与纤溶功能的影响。方法  选取该院收治的80例腹腔镜子宫切除术患者作为研究对象，分为观察组和对照组，每组40例，对照组采用静脉全身麻醉进行腹腔镜全子宫切除术，观察组采用全身麻醉复合硬膜外麻醉进行腹腔镜全子宫切除术。结果  观察组术后血压、心率基本恢复正常，对照组则在术后拔出气管导管后及术后24 h仍高于麻醉前水平。观察组患者在术后24 h内血糖值基本恢复正常（5.0～6.0 mmol/L），对照组患者血糖值>6.0 mmol/L，两者比较差异有统计学意义（P <0.05）。观察组术后抗凝血酶Ⅲ（AT Ⅲ）的各项指标值基本恢复正常，对照组则呈下降趋势。观察组D-二聚体（D-D）、纤维蛋白降解产物（FDP）在术后基本恢复正常，而对照组各项水平明显高于观察组，两组比较差异有统计学意义（P <0.05）。结论  全身麻醉复合硬膜外麻醉能够有效抑制腹腔镜全子宫切除术患者的应激反应和纤溶功能亢进，是理想的麻醉方法，具有临床推广价值。

Abstract:

Objectives To investigate the effects of laparoscopic hysterectomy with general anesthesia combined with epidural anesthesia on stress response and fibrinolytic function. Methods A total of 80 cases undergoing laparoscopic hysterectomy in our hospital were randomly divided into observation group and control group. The observation group had general anesthesia combined with epidural anesthesia, while the control group had general anesthesia. Results The blood pressure (BP) and heart rate (HR) in the observation group returned to normal after operation, while those in the control group were still higher after pulling out the endotracheal tube after anesthesia and 24 hours after operation than the levels before anesthesia. The blood glucose level of the observation group 24 h after operation maintained normal level (5.0-6.0 mmol/L), while that of the control group was higher than 6.0 mmol/L, there was a significant difference between the two groups (P < 0.05). The D-D and FDP levels of the control group were significantly higher than those of the observation group (P < 0.05). Conclusions General anesthesia combined with epidural anesthesia is more effective to inhibit the stress response and hyperfibrinolysis in patients receiving laparoscopic hysterectomy. It is an ideal anesthesia for laparoscopic surgery, thus should be widely promoted and applied in clinic.