腰-硬联合麻醉和连续硬膜外麻醉在阴式子宫切除术的疗效观察

Study on clinical efficacy of combined spinal-epidural anesthesia and continuous epidural anesthesia in vaginal hysterectomy

目的：比较腰-硬联合麻醉和连续硬膜外麻醉两种麻醉方式对阴式子宫切除术患者呼吸循环功能和麻醉效果的影响,探讨两者的临床应用疗效及安全性。方法：60例ASA I~Ⅱ级子宫肌瘤患者,随机分为腰-硬联合麻醉组（CSEA组）和连续硬膜外麻醉组（CEA组）各30例。均取L2~L3间隙行穿刺,CSEA组以连续硬膜外穿刺成功后腰麻针刺破蛛网膜下麻醉,硬膜外置入导管;CEA组硬膜外穿刺成功后置入导管行硬膜外麻醉。监测麻醉起效时间、阻滞完善时间、最高感觉阻滞平面,麻醉前、麻醉注药后1 min、5 min、10min、20 min、30 min时的SBP/DBP、HR、RR、SpO2、运动神经阻滞情况（Bromage氏评分,BMS）和术后疼痛（VAS评分）,评价麻醉效果及安全性。结果：两组麻醉起效时间CSEA组均小于CEA组,BMS评分CSEA组大于CEA组,差异有统计学意义（P〈0.05）;CSEA组和CEA组对呼吸频率和潮气量无明显影响,SpO2〉95%;BP、HR变化无统计学差异（P〉0.05）;麻醉效果评价CSEA组优于CEA组,差异有统计学意义（P〈0.05）;CSEA组和CEA组均无术后严重并发症。结论：CSEA较CEA在阴式子宫切除术中麻醉起效时间快、镇痛效果确切、盆底肌松效果好。

Objective：To compare the effects of combined spinal-epidural anesthesia（CSEA） and continuous epidural anesthesia（CEA） on the respiratory and circulatory functions in vaginal hysterectomy and to study their efficacy and safety.Methods：60 cases of ASAⅠ~Ⅱ uterine myoma were randomly divided into CSEA group and CEA group,30 cases in each group.The anesthetic block effect,initial block time and duration of operation were recorded.SBP/DBP,HR,RR,SpO2 before anesthesia and at 1,5,20,20,30 min after anesthetic injection,BMS,VAS,anesthetic effect and safety were compared between the two groups.Results：The anesthetic onset time in CSEA group was shorter than that in CEA group,while BMS score in CSEA group was more than that in CEA group with statistical difference（P0.05）.RR and tidal volume had no significant difference between the two groups.SpO295%.The change of BP and HR had no statistical difference（P0.05）.CSEA group was superior to CEA group in the anesthetic effects with statistical difference（P0.05）.Conclusion：Compared with CEA,CSEA has fast effective onset time,defined analgesic effect and better relaxation of pelvic floor muscles.