丙泊酚镇静剂量用于腰-硬联合麻醉下妇科腹腔镜手术的可行性

Laparoscopic surgery under combined spinal-epidural anesthesia with propofol at sedative amount

目的:探讨镇静剂量的丙泊酚用于腰-硬联合麻醉下妇科腹腔镜手术的可行性及安全性。方法:选择腰-硬联合麻醉下行妇科腹腔镜手术的患者60例,ASAⅠ～Ⅱ,腰麻阻滞完善后,丙泊酚负荷剂量1mg/kg,连接微量泵泵注丙泊酚25～75μg·kg-1.min-1维持术中镇静。以患者OAA/S评分为镇静指标,并观察对循环和呼吸的变化,分析其麻醉效果、不良反应。结果:术中麻醉效果良好,OAA/S评分3分即为预期的深度,术中各时点收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、脉搏血氧饱和度(SPO2)差异无统计学意义(P<0.05),气腹后5min心率(HR)增快,差异有统计学意义(P<0.05),呼吸(RR)加快,差异有统计学意义(P<0.01),SPO2变化幅度不显著(P>0.05),60例患者均顺利完成手术,无麻醉并发症发生。结论:镇静剂量的丙泊酚用于腰-硬联合麻醉下妇科腹腔镜手术患者的可控性强,在加强麻醉管理和监测的前提下,能很好的控制呼吸和循环功能的变化,同时镇静深度适宜,可有效抑制患者术中的应激反应。

Objective： To discuss the feasibility and security of laparoscopic surgery under combined spi- nal-epidural anesthesia with propofol at sedative amount. Method： Selected 60 patients treated with laparoscopic surgery under combined spinal-epidural anesthesia （ ASA Ⅰ～Ⅱ）. After complete waist anaesthesia block, propofol at loaded dosage of 1 mg/kg and microdose propofol at25～75μg·kg^-1·min^-1 were applied to maintain sedation during surgery. Taking the patient of OAA/S＇s grades as sedative index, observed the variation of circulation and respiration, and analyzed its sedative effect and side effect. Result： Sedative effect was well in surgery. OAA/ s grade was 3 consistent with expected depth. Systolic blood pressure （SBP）, diastolic blood pressure （DBP）, mean arterial pressure （MAP）, or pulse oxygen saturation （SPO2 ） showed no significant differences （P 〉 0.05）, while 5 minute later after pneumoperitoneum, heart rate （HR） and respiration rate （RT） increased significantly （P 〈 0.05）. The variation of PO2 was not significant （ P 〉 0.05 ）. 60 patients had successful surgery without any complication. Conclusion： Propofol with sedative amount can strengthen the control for laparoscopic surgery under combined spinal-epidural anesthesia, regulate the change of eirculation and respiration, keep the appropriate degree of sedation and inhibit the stress response during surgery.