瑞芬太尼梯阶式靶控输注和骶管阻滞在妇科阴式手术麻醉中的应用比较

Anesthesia efficacy of remifentanil given by step target-controlled infusion(TCI) and sacral block in gynecological transvaginal operations

目的比较瑞芬太尼梯阶式靶控输注与骶管阻滞麻醉在妇科阴式手术中的麻醉效果。方法100例妇科阴式手术患者随机分为2组,各50例:瑞芬太尼梯阶式靶控输注组(A组),骶管阻滞麻醉组(B组)。A组:当患者摆好截石位后,开始靶控输注瑞芬太尼,起始靶浓度设定为0.5ng/mL,然后每分钟逐渐增加0.5ng/mL,直至靶浓度达到2.5～3.0ng/mL后,维持靶浓度剂量;B组:以7号注射针头行单次骶管阻滞麻醉。缓慢注入局麻药1.2%利多卡因15～20mL,内含0.25%布比卡因及1:20万肾上腺素。结果A组从麻醉开始至手术开始的时间明显少于B组(P<0.01)。两组心率、MAP无明显变化,均呼吸平稳,无呼吸暂停或呼吸停止的现象发生,在常规面罩吸氧状态下,SPO2>96%。A组:麻醉效果确切,患者对镇痛、镇静效果满意,术者麻醉效果非常满意,麻醉成功率为100%;B组:4例骶管阻滞麻醉失败,改为瑞芬太尼麻醉。46例患者对镇痛、镇静效果满意,术者对麻醉效果满意,麻醉成功率为92%。结论瑞芬太尼梯阶式靶控输注用于妇科阴式手术,是安全可行且易于掌握的麻醉方法。

Objective To compare the anesthesia efficacy of remifentanil given by step target-controlled infusion（TCI） and of sacral block in gynecological transvaginal operations. Methods 100 patients undergoing gynecological transvaginal operations were randomly divided into 2 groups（ 50 each） ： remifentanil given by step TCI （group A）, sacral block（ group 13）. Group A： Remifentanil was given by TCI when patient was placed in lithotomy position. Remifentanil was set at 0.5 ng/mL at the beginning and increased 0.5 ng/mL every minute until 2.5-3.0 ng/mL. Group B： Sacral block was undergoing by 7 gange syringe and 15-20 mL lidocaine, which was composed of 0.25% bupivacaine, and 1：200 000 adrenaline, was injected into sacral canal.Results The time between anesthesia and operation in group A was obviously less than that in group B（ P 〈0 .01）. There were no difference in heart rate and MAP. The two groups were both showed respiratory stable and had no incidence of respiratory arrest. Group A： There were no failure in anesthesia process. Patients were comfortable with sedation and analgesia, and surgeons were satisfied during the operations. Group B： The achievement ratio of sacral block was 92 % because 4 eases were failure. The other 46 patients were comfortable with sedation and analgesia, and surgeons were satisfied during the operations. Conclusion The anesthesia with remifentanil given by step TCI was safe and manageable in gynecological transvaginal operations.