腰麻-硬膜外联合麻醉在经阴道子宫切除术中的应用

Application of Spinal-Epidural Anesthesin in Trans-Vaginal Hysterectomy

目的探讨经阴道子宫切除术时采用腰麻-硬膜外联合麻醉(combined spinal epidural anesthesia,CSEA)与持续硬膜外麻醉(continuous epidural anesthesia,CEA)对血流动力学影响,局麻药用量、阻滞起效时间、临床效果评价等。方法将2009年1月至2009年9月上海市第一妇婴保健院手术室择期行阴道子宫切除术患者80例,随机分为两组:CEA组(n=40)和CSEA组(n=40)(本研究遵循的程序符合同济大学附属第一妇婴保健医院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象本人的知情同意,并与之签署临床研究知情同意书)。两组患者一般情况比较,差异无显著意义(P>0.05)。分别观察、比较CEA,CSEA两组患者麻醉穿刺成功后椎管内注射局部麻醉药5 min,10 min,15 min,30 min及术毕时的血压、平均动脉压(mean arterial pressure,MAP)、心率、静脉血氧饱和度、局麻药用量、麻醉阻滞平面达T8的时间,术中肌组织松弛满意度、术后头痛发生率等。结果两组患者血流动力学比较,CSEA组平均动脉压显著低于CEA组(P<0.05),CSEA组阻滞平面达T8明显快于CEA组(P<0.01),CSEA组局部麻醉药用量明显少于CEA组(P<0.05),CSEA组肌组织松弛满意度优于CEA组(P<0.05)。结论就经阴道子宫切除术而言,腰麻-硬膜外联合麻醉是经阴道子宫切除术的一种理想的麻醉方法。

Objective To compare the anesthetic effects and hemodynamic changes between combined spinal-epidural anesthesia（CESA） and continuous epidural anesthesia （CEA） in trans vaginal hysterectomy. Methods From January to September 2009, 80 patients who were underwent trans vagina hysterectomy were randomly divided into two groups, CSEA group （n=40） and CEA group （n=40）. Informed consent was obtained from all participates. There had no significant difference of the general situation between two groups（P〉0.05）. In CEA group, epidural anesthesia was established using （20-30） mL 2% lidocaine with epinephrine, whereas spinal anesthesia was performed using （2.0-3.0） mL hyperbaric 0.75G bupivacaine in CSEA group. The blood pressure, heart rate, Spo2 were monitored continuously during surgery. The changes of hemodynamic, anesthetic dosage, times of sensory block to T8, degrees of motor block and muscle relaxation, and postoperative headache were measured and analyzed. Results The mean arterial pressure（MAP） of CSEA group was significant lower than that of CEA group（P〈0.05）, times of sensory block to T8 was quicker in CSEA group than that of CEA group （P〈0.01）, anesthetic dosage of CSEA group was lower than that of CEA group （P〈0.05）, and muscle relaxation and motor block were much better in CSEA group （P〈0. 05）. Conclusion Compared with continuous epidural anesthesia, combined spinal-epidural anesthesia is a perfect anesthetic option for trans vaginal hysterectomy with smaller anesthetic dosages, quicker onset time and reliable muscle relaxation.