西宁地区妇科腹腔镜手术的麻醉体会

The Use of Spinal Anesthesia Combined with Intravenous Anesthesia in Gynecological Laparoscopic Surgery in Xining

目的:探讨西宁地区妇科腹腔镜手术腰麻联合静脉复合麻醉的可行性。方法:60例行腹腔镜下卵巢囊肿摘除患者,随机分为气管插管全麻组(A组30例)和腰麻联合静脉复合麻醉组(B组30例),观察麻醉效果和气腹效果及脉搏氧饱和度(SpO2)、心率(HR)、血压(SBP),分时段抽动脉血进行血气分析。结果:两组患者年龄、体重及气腹前SBP、DBP、UR、SpO2无显著差别(P>0.05),气腹效果优良率分别为100%,66.7%(P<0.05),组间比较差别有显著性。B组出现7例呼吸困难,SpO2下降,A组无;两组比较有明显差别(P<0.01);两组的血气分析,A组气腹后10min,PaO2明显高于B组,组间比较差别有显著性(P<0.05)。结论:腰麻联合静脉复合麻醉用于妇科腹腔镜下卵巢囊肿摘除术是可行的,其中7例呼吸困难与静脉复合麻醉时所用瑞芬太尼有关,面罩加压给氧,调整瑞芬太尼的用量可避免呼吸困难的发生率。在手术时间大于1h的手术,仍以全麻插管控制呼吸为主。

Objective: To observe the effects of spinal anesthesia combined with intravenous anesthesia on gynecological laparoscopic surgery.Methods: 60 women,who would be performed the ovarian cysts surgery by routine laparoscopy,randomly divided into the tracheal intubation anesthesia group(group A) and the spinal anesthesia combined with intravenous anesthesia group(group B) 30 each.The Efficiency of anesthesia and pneumoperitoneum,pulse,oxygen saturation(SaO2),heart rate(HR),blood pressure(BP) were examined;and artery blood gas was analyzed at a time phase.Results:No difference in BP,SaO2 and HR between two groups before pneumoperitoneum(P>0.05). The effective rate of pneumoperitoneum in the group A and group B was 100% and 60% respectively(P<0.05).7 cases with dyspnia and level of SPO2 decreased in the group B excluded group A,there was significant difference between the two groups(P<0.01).PaO2 was higher in group A after 10min pneumoperitoneum(P<0.05).Conclusions: Spinal anesthesia combined with intravenous anesthesia is feasible in ovarian cyst surgery using gynecological laparoscopy,of which seven cases with dyspnia correlated with use of remifentanil and can be released by pressurized oxygen masks and adjustment of remifentanil dosage.