全子宫切除术中腰麻联合硬膜外麻醉的比较研究

Comparative study on combined spinal epidural anesthesia in complete hysterectomy

目的：比较腰麻联合硬膜外麻醉与连续硬膜外麻醉在全子宫切除手术中的麻醉效果及其对血流动力学的影响．方法：选择期行全子宫切除手术患者１５８例，随机分为两组． Ａ组７８例，行腰麻联合硬膜外麻醉；Ｂ组８０例，行单纯连续硬膜外麻醉． 结果：腰麻联合硬膜外麻醉较单纯连续硬膜外麻醉起效时间快，阻滞范围广，肌肉松驰完善，局麻药用量小，呈显著差异（Ｐ＜ ０．０１）；二者在初次用药后１ ｈ 内的低血压发生率、血压波动以及麻黄碱用量等无明显差异，但血压下降最低值出现时间Ａ 组明显早于Ｂ组（Ｐ＜ ０．０１）；腰麻联合硬膜外麻醉后头痛发生率低，仅占１．２８％ ． 结论：腰麻联合硬膜外麻醉为全子宫切除手术提供了一种起效迅速、神经阻滞完善、合并症较少的麻醉方法．

AIM: To evaluate the efficacy and hemodynamic changes of a combined spinal epidural anesthesia (CSEA) in comparison with a continuous epidural anesthesia (CEA) in complete hysterectomy. METHODS: One hundred and fifty eight patients scheduled to undergo complete hysterectomy were randomly assigned to two groups: Seventy eight patients received CSEA in group A and eighty patients received CEA in group B. RESULTS: Compared with the CEA group, CSEA group had the advantage of earlier onset times, more intensive motor block and smaller dose of local anesthetics ( P <0.01). There was no difference between the two groups in the incidence of hypotension, ephedrine dose and postoperation backache and headache ( P >0.05). But the time in which Bp decreased to the valley during 60min after the first injection in CSEA group was significantly shorter than that in CEA group ( P <0.01). CONCLUSION: CSEA provides a better operation condition for total hysterectomy.