ABSTRACT
Objective To investigate the application value of general anesthesia combined with epidural anesthesia in patients with cervical cancer after laparoscopic hysterectomy.Methods From January 2014 to November 2016,64 patients with cervical cancer in Beijing Ditan Hospital were selected and randomly divided into control group and study group,with 32 cases in each group.Both two groups were treated with laparoscopic hysterectomy,and the control group was treated with general anesthesia,the study group was treated with general anesthesia combined with epidural anesthesia.The amount of general anesthesia,the time of surgery and postoperative recovery time,the incidence of adverse reactions,preoperative and postoperative oxidative stress－related indicators[metabolic enzyme monoammine oxidase A (MAOA),enzyme tyrosine hydroxylase (TH),glutathione peroxidase (GSH－Px),5 －hydroxytryptamine (5 －HT)]were statistically compared between the two groups.Results The operative time,postoperative recovery time and doage of atracurium,remifentanil,propofol in the study group were less than those in the control group (t＝6.928,11.205,16.966,7.798,16.839,all P＜0.01).There were no statistically significant differences in the MAOA,TH,GSH－Px and 5 －HT levels between the two groups before treatment (all P＞0.05),but after operation, the MAOA,TH and 5 －HT levels in the study group were significantly lower than those in the control group,the GSH－Px level was significantly higher than that of the control group,the differences were statistically significant (t＝28.585,26.346,10.850,21.827,all P＜0.01).The incidence rates of cardiac tachycardia[18.75%(6/32)],vomiting and nausea[15.63%(5/32)],and restless[9.38%(3/32)]in the study group were lower than those in the control group[43.75%(14/32),37.50%(12/32),40.63%(13/32)],the differences were statistically significant (χ2＝4.655,3.925,8.333,all P＜0.05).Conclusion General hysterectomy combined with epidural anesthesia in patients with cervical cancer after laparoscopic hysterectomy can effectively reduce the postoperative oxidative stress,reduce the dosage of narcotic drugs and the time of operation and wake up,and the incidence rate of adverse reactions is low.
ABSTRACT
Objective To explore and compare the clinical effects of pregnant women with liver cirrhosis after hepatitis in cesarean section between general anesthesia and single spinal anesthesia.Methods Clinical data of pregnant women of 35,including compensated cirrhosis 26 cases,decompensated cirrhosis 9 cases,aged 24-45 years,weighing 55-98 kg,falling into ASA Ⅱ or Ⅲ,were divided into group A (general anesthesia group,n=15) and B (single spinal group,n=20).In patients of group A,propofol were infused at 1.5 mg/kg till the time for fetal delivery,after intubation,followed by infusion of remifentanil at a rate of 0.2 μg·kg-1·min-1 TCL combined with propofol until the end of operation.In group B,the puncture was performed at L3-4 interspace,following by intrathecal injection of ropivacaine 10~15 mg and within 10 seconds.With liver cirrhosis after hepatitis were collected and analyzed,retrospectively.Preoperative general status,blood loss and time of operation,Apgar score of neonates compared and analyzed in groups A and B.And the changes of hepatic function and coagulation function of the body under different anesthesia methods were also studied.The influential factors of postoperative elevation of hepatic function were analyzed by non-conditional logistic regression models.Results Blood loss and time of operation,Apgar score of neonates and postoperative hospital stay had no significant differences between the two groups.Postoperative albumin of group A was higher than that of preoperative,with a statistical significance (P<0.05).Alanine aminotransferase,aspartate aminotransferase of postoperative of group B were increased,with a statistical significance (P<0.01).Logistic analysis showed that the type of anesthesia was the possible influencing factor of postoperative elevation of total bilirubin (OR=12.04,95%CI 1.14-127.45).Conclusion The negative effect of single spinal anesthesia on hepatic function more than that of general anesthesia in pregnant women with liver cirrhosis in cesarean section.