腰麻硬膜外联合麻醉在不同手术患者的临床应用和比较

Comparison of clinical using combined spinal-epidural anesthesia in different operative patients

目的比较腰麻硬膜外联合麻醉在妇科、产科、老年及普外手术患者的临床应用.方法选择160例ASAⅠ-Ⅱ级患者实施腰硬联合麻醉,包括腹式全子宫切除,剖宫产,经尿道前列腺电切(TURP)和脐以下部位普外手术各40例.一点法针过针技术L3～L4间隙穿刺,穿刺成功后见脑脊液,注入2ml的0.75%布比卡因2ml+50%葡萄糖1ml混合液.记录观察血液动力学变化和各种副作用.结果所有患者均取得满意的麻醉效果无呼吸困难和麻醉后头痛.在剖宫产,子宫切除,TURP和普外手术患者平均动脉压与蛛网膜下腔用药前相比下降＞30%患者的比率分别是22.2%、10.3%、2.6%、7.5%,心动过缓(＜55次/分)的患者分别为11.1%、2.6%、0%、2.5%,与其他三组患者相比剖宫产术实施腰硬联合麻醉有明显多的患者出现低血压和心动过缓(P＜0.05).结论腰硬联合麻醉可以安全地用于妇女、产妇、老年及普外患者下腹部以下部位手术并取得非常满意的麻醉效果.

Objective To compare the clinical application of combined spinal-edidural anesthesia (CSEA) in middle aged women,preganacy women,elderly and general surgical patients.Methods 160 ASA Ⅰ~Ⅱpatients each 40 cases undergoing abdominal hysterectomy,cesarean section ,TURP and general surgical operation were selected to receive CSEA. Epidural space was identified at L3-4 intervertebral space ,dural puncture was performed using needle through needle technique.After success in obtaining cerebrospinal fluid 2 ml mixed of 0.75% bupivacaine 2ml +50% glucose 1ml was injected into subarachnoid space.Hemodynamic changes and other side effects were recorded.Results All patients had satisfactory anesthetic effects without respiratory difficulty and post-operative headache.Incidences of hypotension as >30% decreased of mean arterial pressure on patients undergoing cesarean section,abdominal hysterectomy, and general surgical operation were 22.2%,10.3%,2.6%,7.5%,and incidences of bradycardia (<55/min) were 11.1%,2.6%,0%,2.5% respectively.Patients undergoing cesarean section had high incidences of hypotension and bradycardia compared with other three groups patients (P<0.05). Conclusions Combined spinal-epidural anesthesia can be very safely used on patients undergoing cesarean section, abdominal hysterectomy,and general surgical operation with good anesthetic effects.