妇科手术病人不同麻醉方法绩效的比较

Cost-effectiveness of different methods of anesthesia for gynecologic surgical procedures

目的比较妇科手术病人单纯全麻和硬膜外复合全麻的绩效。方法择期妇科手术病人30例，年龄18～64岁，ASAⅠ或Ⅱ级，随机分为2组（n=15）：单纯全麻组（G组）和硬膜外复合全麻组（EG组）。EG组硬膜外注射2％利多卡因试验剂量3ml。两组静脉注射地塞米松、氟哌利多、芬太尼、异丙酚和琥珀酰胆碱麻醉诱导，气管插管后机械通气。G组吸入七氟醚及间断静脉注射芬太尼维持麻醉；EG组吸入七氟醚及间断硬膜外注射利多卡因和丁卡因维持麻醉；两组静脉注射维库溴铵维持肌松。术毕入PACU，G组采用病人自控静脉镇痛；EG组采用病人自控硬膜外镇痛。记录苏醒时间、拔管时间和PACU停留时间；记录七氟醚、芬太尼、肌松药和血管活性药物用量；于术后6、24、48h时记录静息状态和活动状态的VAS评分以及镇痛泵实际按压次数和有效按压次数；记录术后不良反应的发生情况；计算麻醉有关费用。结果与G组比较，EG组拔管时间和PACU停留时间缩短，七氟醚和芬太尼用量减少，术后6h时实际按压次数和有效按压次数减少（P〈0．05或0．01），苏醒时间、各时点镇痛效果、不良反应发生率和麻醉总费用差异无统计学意义（P〉0．05）。结论与单纯全麻相比，妇科手术病人硬膜外复合全麻麻醉药物用量少，术后早期镇痛效果好，且麻醉总费用相当。

Objective To compare the cost-effectiveness of simple general anesthesia and general anesthesia combined with epidural boek in patients undergoing gynecologic surgical procedures. Methods Thirty ASA Ⅰ or Ⅱ patients aged 18-64 yr undergoing elective gynecologic surgical procedures were randomly divided into 2 groups （n = 15 each） ： group Ⅰ simple general anesthesia （G） and group Ⅱ general anesthesia ＋ epidural block （EG）. BP, HR, PETCO2 and BIS were monitored during anesthesia. In group EP epidural catheter was placed at L2,3 interspace. Correct catheter placement was confirmed with 3 ml of 2% lidocaine. General anesthesia was induced with dexamethasone 10 rag, droperidol 1.25 mg, fentanyl 3 μg/kg, propofol 2 mg/kg and suceinylcholine in both groups. The patients were intubated and mechanically ventilated. Anesthesia was maintained with sevoflurane and intermittent iv boluses of fentanyl and vecuronium in group G and with sevoflurane and intermittent iv boluses of vecuronium and epidural 1% lidocaine ＋ 0.2 % dicaine in group EG respectively. The patients were admitted to PACU after operation and received patient-controlled intravenous analgesia （PCIA） in group G or patient-controlled epidural analgesia （PCEA） in group EG. The recovery time, extubation time, length of stay in the PACU and the amount of sevoflurane, fentanyl, muscle relaxant and vasoaetive agents consumed were recorded. VAS score was assessed at 6, 24 and 48 h after operation when the patients were active or at rest. The number of successful delivered doses and the number of attempts were recorded. The adverse reactions were recorded and the cost of anesthesia was calculated. Results The extubation time and length of stay in PACU were significantly shorter and less amount of sevoflurane and fentanyl were consumed in group EG than in group G. The number of successful delivered doses and the number of attempts at 6 h after operation were significantly smaller in group EG than in group G（P 〈 0.05 or 0.01）. There was no significant difference in recovery time,VAS scores, incidence of adverse reactions and the total costs of anesthesia between the 2 groups（ P 〉 0.05）. Conclusion Less anesthetics are consumed and the patients experience less pain after operation in group EG than in group G while the cost of anesthesia is comparable between the 2 groups.