Abstract: Objective　To explore the effects of different anesthesia maintenance regimens on anesthetic effects and hemodynamics in patients undergoing laparoscopic total hysterectomy. Methods　Sixty-eight patients who were scheduled to undergo laparoscopic total hysterectomy in Xiamen Huli District Maternity and Child Care Hospital from December 2016 to December 2019 were selected and were randomly divided into a control group (34 cases) and an observation group (34 cases) by the sealed envelope method. The control group was (48.73±6.52) years old with (2.86±0.58) births, and the observation group was (49.24±6.87) years old with (2.92±0.63) births. The control group adopted intravenous-inhalation combined anesthesia maintenance regimen of remifentanil target-controlled infusion and intermittent inhalation of sevoflurane, and the observation group adopted simple intravenous maintenance anesthesia regimen of target-controlled infusion of propofol and remifentanil. The anesthetic effects, hemodynamic indexes before anesthesia induction (T₀), after anesthesia induction (T₁), at tracheal intubation (T₂), 5 min after establishment of pneumoperitoneum (T₃), at the end of surgery (T₄), at extubation (T₅), and 30 min after extubation (T₆), and adverse reactions of the two groups were compared. Repeated-measure ANOVA or independent sample t test was used for the measurement data, and χ² test was used for the count data. Results　The anesthesia induction time, postoperative wake-up time, extubation time, and recovery time of orientation were shorter and the incidence of postoperative agitation [5.88% (2/34) vs. 29.41% (10/34)] was lower in the observation group compared to those in the control group (all P<0.05). At T₀-T₆, the systolic blood pressure, diastolic blood pressure, and heart rate in the two groups were fluctuated significantly (all P<0.05), and the systolic blood pressure, diastolic blood pressure, and heart rate in the observation group at T₂ and T₃ were significantly lower than those in the control group (all P<0.05). In terms of postoperative adverse reactions such as nausea and vomiting, dizziness, drowsiness, and bradycardia, there were 3 cases in the observation group and 5 cases in the control group, and there was no statistically significant difference between the two groups (P>0.05). Conclusion　The anesthetic effect of simple intravenous anesthesia maintenance in laparoscopic total hysterectomy is better than that of intravenous-inhalation combined anesthesia maintenance, and the former regimen is beneficial to hemodynamic stability and reduce the risk of stress response, with fewer adverse reactions.

Key words: Laparoscopic total hysterectomy, Intravenous-inhalation combined anesthesia, Simple intravenous anesthesia, Anesthetic effect, Hemodynamics

摘要： 目的　探究不同麻醉维持对腹腔镜下全子宫切除术患者麻醉效果及血流动力学的影响。方法　选择2016年12月至2019年12月拟于厦门市湖里区妇幼保健院行腹腔镜下全子宫切除术的68例患者，用密封信封法随机分组为对照组（34例）与观察组（34例）。对照组患者年龄（48.73±6.52）岁，产次（2.86±0.58）次；观察组患者年龄（49.24±6.87）岁，产次（2.92±0.63）次。对照组予以瑞芬太尼靶控输注联合间断吸入七氟醚的静吸复合麻醉维持，观察组予以丙泊酚和瑞芬太尼靶控输注的单纯静脉维持麻醉，比较两组患者麻醉效果、血流动力学指标［麻醉诱导前（T₀）、麻醉诱导后（T₁）、气管插管时（T₂）、建立气腹后5 min（T₃）、术毕（T₄）、拔管时（T₅）、拔管后30 min（T₆）7个时刻］与不良反应情况。计量资料采用重复测量方差分析或独立样本t检验，计数资料采用χ²检验。结果　相比于对照组，观察组麻醉诱导和术后苏醒、拔管、定向力恢复的时间更短（均P<0.05），观察组术后躁动2例（5.88%），对照组术后躁动10例（29.41%），两组躁动发生率对比差异有统计学意义（P<0.05）；T₀~T₆时刻，两组患者收缩压、舒张压及心率水平均存在明显波动（均P<0.05），观察组患者T₂与T₃时刻的收缩压、舒张压及心率水平均显著低于对照组（均P<0.05）；两组患者术后不良反应如恶心呕吐、头晕、嗜睡、心动过缓，观察组发生3例，对照组发生5例，对比差异无统计学意义（P>0.05）。结论　单纯静脉麻醉维持方案在腹腔镜下全子宫切除术中的麻醉效果优于静吸复合麻醉维持方案，且有利于患者血流动力学稳定、降低应激反应发生风险，不良反应较少。

关键词: 腹腔镜下全子宫切除术, 静吸复合麻醉, 单纯静脉麻醉, 麻醉效果, 血流动力学