目的：探讨基于超声实时引导的精准骶管阻滞联合喉罩全麻对阴式子宫切除手术患者术中应激反应及术后肠功能恢复的影响。方法：本研究采用前瞻性、单中心随机对照试验，选取2023年1月至2025年1月于我院择期行阴式子宫切除术的患者108例，随机分为对照组（n=54）和观察组（n=54）。对照组行单纯喉罩全身麻醉，观察组行超声实时引导精准骶管阻滞（0.25%罗哌卡因20 mL）联合喉罩全身麻醉。比较两组患者术中不同时间点血流动力学指标[平均动脉压（MAP）、心率（HR）]、应激反应指标[血清皮质醇（COR）、去甲肾上腺素（NE）、血糖（GLU）]、术后肠功能恢复指标（肠鸣音恢复时间、首次排便时间、首次排气时间）、术后疼痛视觉模拟评分（VAS）、术后镇痛泵有效按压次数、补救镇痛率及不良反应发生率。主要结局指标为术后24 h VAS评分，次要结局指标包括术中应激反应指标和术后肠功能恢复指标。结果：两组患者年龄、BMI、手术时间及术中出血量比较，差异均无统计学意义（P>0.05）。与T0时点比较，两组T1、T2、T3时点MAP、HR均升高，但观察组T1、T2、T3时点MAP、HR均低于对照组（P<0.05）。两组T1、T2、T3时点COR、NE、GLU水平均高于T0时点，但观察组T1、T2、T3时点COR、NE、GLU水平均低于对照组（P<0.05）。观察组术后肠鸣音恢复时间、首次排便时间及首次排气时间均短于对照组（P<0.05）。观察组术后2 h、6 h、12 h、24 h VAS评分均低于对照组（P<0.05），术后镇痛泵有效按压次数及补救镇痛率均低于对照组（P<0.05）。观察组术后恶心呕吐（PONV）发生率低于对照组（P<0.05），两组尿潴留发生率比较差异无统计学意义（P>0.05）。结论：基于超声实时引导的精准骶管阻滞联合喉罩全麻可有效减轻阴式子宫切除手术患者术中应激反应，维持血流动力学稳定，促进术后肠功能恢复，提高术后镇痛质量，且不增加不良反应发生率，值得临床推广应用。

Objective: To investigate the effects of ultrasoundguided realtime precise caudal block combined with laryngeal mask airway (LMA) general anesthesia on intraoperative stress response and postoperative bowel function recovery in patients undergoing vaginal hysterectomy. Methods: This prospective, singlecenter randomized controlled trial enrolled 108 patients who underwent elective vaginal hysterectomy in our hospital from January 2023 to January 2025. They were randomly divided into a control group (n=54) and an observation group (n=54). The control group received LMA general anesthesia alone, while the observation group received ultrasoundguided realtime precise caudal block (0.25% ropivacaine 20 mL) combined with LMA general anesthesia. The following parameters were compared between the two groups: hemodynamic variables [mean arterial pressure (MAP), heart rate (HR)] at different intraoperative time points, stress response indicators [serum cortisol (COR), norepinephrine (NE), blood glucose (GLU)], postoperative bowel function recovery indicators (time to bowel sound recovery, time to first defecation, time to first flatus), postoperative pain Visual Analog Scale (VAS) scores, effective pressing times of patientcontrolled analgesia (PCA) pump, rescue analgesia rate, and incidence of adverse reactions. The primary outcome was the 24 h postoperative VAS score; secondary outcomes included intraoperative stress response indicators and postoperative bowel function recovery indicators. Results: No significant differences were found between the two groups in age, BMI, operative time, or intraoperative blood loss (P>0.05). Compared with T0, MAP and HR at T1, T2 and T3 were increased in both groups, but the MAP and HR at T1, T2 and T3 in the observation group were significantly lower than those in the control group (P<0.05). Levels of COR, NE and GLU at T1, T2 and T3 were higher than those at T0 in both groups, but the levels in the observation group were significantly lower than those in the control group at the corresponding time points (P<0.05). The time to bowel sound recovery, time to first defecation and time to first flatus in the observation group were significantly shorter than those in the control group (P<0.05). The VAS scores at 2 h, 6 h, 12 h and 24 h postoperatively in the observation group were significantly lower than those in the control group (P<0.05); the effective pressing times of PCA pump and the rescue analgesia rate in the observation group were also significantly lower than those in the control group (P<0.05). The incidence of postoperative nausea and vomiting (PONV) in the observation group was significantly lower than that in the control group (P<0.05), whereas no significant difference was observed in the incidence of urinary retention between the two groups (P>0.05). Conclusion: Ultrasoundguided realtime precise caudal block combined with LMA general anesthesia can effectively alleviate intraoperative stress response, maintain hemodynamic stability, promote postoperative bowel function recovery, and improve postoperative analgesia quality in patients undergoing vaginal hysterectomy, without increasing the incidence of adverse reactions. Therefore, this combined anesthesia technique is worthy of clinical application.

目的 观察喉罩通气下全凭七氟醚吸入麻醉在妇科宫腔镜手术中的应用价值。方法 60例拟行妇科宫腔镜手术的患者随机分为七氟醚和丙泊酚组,每组30例,记录不同时间点两组患者的平均动脉压(MAP),脉搏血氧饱和度(SpO₂)、苏醒时间以及术后恶心,呕吐、躁动的发生率。结果 A组患者血流动力学指标波动较少,苏醒时间A组明显短于B组,差异有显著性(P<0.05)。两组患者诱导后MAP,HR均较诱导前显著下降(P<0.05)。B组患者术中MAP,HR值显著低于A组(P<0.05),拔除喉罩即刻两组MAP,HR差异无显著性(P>0.05)。结论 喉罩下全凭七氟醚吸入麻醉对患者的血流动力学的影响较小,适用于妇科宫腔镜手术。

Objective To observe the effect of laryngeal mask airway(LMA) combined with sevoflurane inhalation anaesthesia in gynecological hysteroscopy operation. Methods Sixty patients, classified from ASAⅠtoⅡscheduled for hysteroscopic operation were randomly divided into sevoflurane inhalation anesthesia group (group A) and propofol intravenous anesthesia group(group B).The mean arterial pressure (MAP), pulse oxygen saturation (SpO₂), recovery time and the incidence of nausea, vomiting and recovery time were recorded at different time points of the two groups. Results The hemodynamic index of the patient in the group A fluctuated seldom,and the recovery time was significantly shorter than that in the B group, and the differences were significant (P<0.05).The MAP and the HR were all decreased after anesthesia induction compared with those of before in both groups (P<0.05).The MAP and the HR in the group B was significantly lower than that in the group A (P<0.05), there were no significant differences in MAP and HR between the two groups of patients with laryngeal mask airway removal. Conclusion Small hemodynamic influence is taken with the technique of laryngeal mask airway(LMA) combined with sevoflurane inhalation anesthesia. It is suitable for gynecological hysteroscopic operation.