腰-硬联合麻醉在阴式子宫切除术中的应用

Application of Combined Spinal-epidural Analgesia in Transvirginal Hysterectomy

目的探讨腰-硬联合麻醉(CSEA)用于阴式子宫切除术的临床效果与安全性。方法将择期行阴式子宫切除术患者60例随机分为CSEA组和单纯硬膜外麻醉组(EA组)2组,每组30例。穿刺点均选择L2-3间隙,穿刺成功后CSEA组给予0.75%布比卡因2 mL;EA组先给予2%利多卡因试验量5 mL,后用1%罗哌卡因维持麻醉。观察2组患者基本生命体征变化、局麻药与静脉辅助药用量及手术后不良反应情况;比较2组麻醉效果。结果CSEA组术中局麻用药量小于EA组;CSEA组术中无需静脉辅助药,EA组术中需给予静脉辅助药,以消除患者因牵拉反应所引起的不适感。麻醉效果优良率CSEA组100.0%,EA组86.7%,2组相比,差异有统计学意义(P<0.05),2组术后匀未见明显不良反应。结论CSEA用于阴式子宫切除术安全,而且效果好。

Objective To evaluate the clincal effectiveness and security of combined spinaleqidual anesthesia（CSEA） in transvaginal hysterectomy. Methods Sixty patients were were randomized into CSEA group and epidural anesthesia （EA） group,30 cases in each one. Lumbar intervertebral space 2--3 were selected in each group. The drug 0.75% bupivacaine 2 mL was given in subarachnoid space in group CSEA and the test dose 2 % dolicaine 5 mL was given in epidural space in group EA when pricking succeed. Patient＇s basic vital sign and the relaxation level of cervix uteri and adverse effect in postoperation were recorded. Results Compared with group EA, less local anesthetic was used and no vein adjuvant injected intraoperation in group CSEA. Vein adjuvant was injected to eliminate the uncomfortableness caused of dragging reaction intraoperation in group EA. The difference of the favorable effection of anesthesia is significance between group CSEA and group EA（100.0% vs 86.7% ,P〈0.05）. And no unto effect appeared postoperation in two groups. Conclusion The satisfactory clinical effectiveness and security can be obtained in CSEA during transvirginal hydsterectomy.