南方医科大学学报

南方医科大学学报 ›› 2022, Vol. 42 ›› Issue (4): 591-597.doi: 10.12122/j.issn.1673-4254.2022.04.16

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经阴道分娩史对静脉全麻下宫腔镜手术患者麻醉管理的影响——99例前瞻性临床试验

于晓萌，郭 英，公茂伟，王苗苗，闫志风，孙 立，娄景盛   

  1. 解放军总医院第一医学中心麻醉科，妇产科，北京 100853
  • 出版日期:2022-04-20 发布日期:2022-05-05

Impact of vaginal delivery history on anesthesia management of hysteroscopic surgery under intravenous general anesthesia: a cohort study of 99 patients

YU Xiaomeng, GUO Ying, GONG Maowei, WANG Miaomiao, YAN Zhifeng, SUN Li, LOU Jingsheng   

  1. Department of Anesthesiology, Department of Obstetrics and Gynecology, First Medical Center, General Hospital of PLA, Beijing 100853, China
  • Online:2022-04-20 Published:2022-05-05

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摘要： 目的 评估接受非插管静脉全麻下宫腔镜手术女性患者，其术前经阴道分娩史对术中麻醉管理的影响。方法 收集非插管静脉全麻下宫腔镜手术患者99例，依据是否有经阴道分娩史分为有经阴道分娩史组（VD组，43例）和无经阴道分娩史组（NVD组，56例），比较两组患者：①麻醉前（T1）、麻醉后（T2）、扩宫后（T3）以及扩宫后3 min（T4）的血压、心率、血氧饱和度（SpO2）、脑电双频指数（BIS）变化及血管活性药应用情况；②两组患者麻醉术中丙泊酚和依托咪酯诱导剂量、丙泊酚应用总量、丙泊酚追加剂量及次数、患者术中体动情况、呼吸抑制情况、手术时长、手术医生满意度评分；③术后清醒时长、术后恢复时长、术后30 min疼痛视觉模拟评分（VAS)及术后恶心呕吐发生情况。结果 两组患者T1与T2时间点收缩压、舒张压、心率、SpO2变化均未见差异；T3、T4时点NVD组较VD组收缩压、舒张压明显升高（P<0.01）；NVD组心率在T3时点明显升高，T4时点未见差异；两组患者术中应用血管活性药物差异无统计学意义（P>0.05）；NVD组丙泊酚应用总量、术中丙泊酚追加剂量和次数均大于VD组（P<0.01）；NVD组术中发生体动次数更多（P<0.01），手术医生满意度评分更低（P<0.01），术毕清醒（P<0.05）和恢复时间更长（P<0.01），术后疼痛VAS评分更高（P<0.05），其余结果无统计学意义。结论 术前是否存在经阴道分娩史明显影响非插管静脉全麻下宫腔镜手术患者麻醉管理，其围术期血流动力学变化、麻醉用药以及术后恢复质量等均发生明显变化，提示在此类手术中，需要根据患者不同分娩史进行差异化麻醉围术期管理。

关键词: 麻醉管理；静脉全麻；宫腔镜手术；经道阴分娩史；前瞻性研究

Abstract: Objective To evaluate the impact of a history of vaginal delivery on anesthesia management of patients undergoing hysteroscopic surgery under intravenous general anesthesia without tracheal intubation. Methods Ninety-nine patients undergoing hysteroscopic surgery under intravenous general anesthesia were enrolled in this study, including 43 patients with (VD group) and 56 patients without a history of vaginal delivery (NVD group). For all the patients, blood pressure, heart rate (HR), blood oxygen saturation (SpO2) and bispectral index (BIS) were recorded before anesthesia (T1), after anesthesia (T2), after cervical dilation (T3), and at 3 min after cervical dilation (T4). Propofol and etomidate doses during anesthesia induction, the total dose of propofol administered, additional intraoperative bolus dose and times of propofol, intraoperative body movement, total operation time and surgeons' satisfaction feedback scores were compared between the two groups. The postoperative awake time, recovery time, VAS score at 30 min after operation, and postoperative nausea and vomiting (PONV) were also compared. Results There was no significant differences in SBP, DBP, HR, SpO2, or BIS between the two groups at T1 and T2, but at T3 and T4, SBP and DBP were significantly higher in NVD group than in VD group (P<0.01); HR was significantly higher in NVD group only at T3 (P<0.01). The application of vasoactive drugs did not differ significantly between the two groups. The total dose of propofol, additional intraoperative dose and times of propofol were all greater in NVD group than in VD group (P<0.01). More body movements of the patients were observed in NVD group (P<0.01), which also had lower surgeons' satisfaction score for anesthesia (P<0.01), higher postoperative VAS score (P<0.05), and shorter postoperative awake time (P<0.05) and recovery time (P<0.01). Conclusion A history of vaginal delivery has a significant impact on anesthesia management of patients undergoing hysteroscopic surgery under intravenous general anesthesia without tracheal intubation in terms of hemodynamic changes, anesthetic medication, and postoperative recovery quality, suggesting the necessity of individualized anesthesia management for these patients.

Key words: anesthesia management; intravenous general anesthesia; hysteroscopic surgery; vaginal delivery history; prospective cohort Study