改良腰-硬联合麻醉用于妇科手术的临床观察

Clinical observation of modified combined spinal-epidural anesthesia for gynecological operation

目的:探讨改良腰-硬联合麻醉与单纯连续硬膜外麻醉在妇科手术的应用价值。方法:对60例拟行妇科手术的患者术前随机分为CSE组(改良两点法腰-硬联合麻醉)与EP组(连续硬膜外麻醉)两组,对两组麻醉起效时间、局麻药用量、无痛率、肌松满意度、麻醉前、麻醉开始时5、10、20、30、40分钟(MAP)和HR的变化进行比较,记录术中低血压、恶心、呕吐和寒战发生率,术后48小时头痛、腰背痛等并发症的发生情况。结果:CSE组患者的麻醉起效时间快,麻醉平面达T6时间和最高平面时间短,而且镇痛效果、肌松效果好,与EP组比较有统计学意义(P<0.05或P<0.01)。术中低血压、恶心、呕吐、寒战等并发症发生率两组无统计学意义。两组患者的血流动力学变化,EP组用药后MAP缓慢下降,25分钟时出现明显下降(P<0.05);CSE组MAP下降迅速,15分钟时即出现显著性下降(P<0.05)。结论:改良两点法腰-硬联合麻醉安全简便,效果确切。

Objective：To investigate the. clinical value of modified combined spinal-epidural anesthesia and simple continuous epidural anesthesia in the gynecological operation.Methods：60 patients drawn up for gynecological operation were randomly divided into the modified combined spinal-epidural anesthesia （CSE group） and simple comtinuous epidural anesthesia （EP group）.The effectual time, drug dose,the painless rate,the mulse-loose degree of satisfaction,the changes of MAP and HR before and 5,10,20,30,40 minutes after anesthesia in two groups were compared,and the incidence of hypotension,disgusting,vomiting and shiver during operation and the occurrence situation of beadache,backacbe and so on 48 hours after operation were recorded respectively.Results：Compared with the EP group, the effectual time of anesthesia in the CSE group was quick,the time of anesthetic plane to the T6 and the highest plane was short and the analgesic effect and mulse-loose effect were good with statistical differences between two groups （P〈0.05 or P〈0.01）,but without statistical differences in hypotension,disgusting,vomiting shiver and so on during operation.After medication,MAP in the EP group decreased slowly, and was obviously decreasing at 25 minutes （P〈0.05）;MAP in the CSE group decreased rapidly,and was significantly decreasing at 15 minutes （P〈0.05）. Conclusion：Modified combined spinal-epidural anesthesia is safe and simple,its effect is accurate.