腰-硬联合麻醉在阴式全子宫切除术中的应用

The onset time of sensory and motor block,degree of motor block,the height of sensory and the quality of anesthesia

目的评价腰-硬联合麻醉(CSEA)用于阴式全子宫切除术(TVH)的麻醉效果。方法选择择期行阴式全子宫切除术的患者100例,ASAⅠ～Ⅱ级,年龄35～55岁,随机分为腰-硬联合麻醉(CSEA)组和硬膜外麻醉(EA)组,每组50例。记录2组患者的局麻药用量、感觉阻滞起效时间、阻滞平面、阻滞完善时间、痛觉恢复时间、改良Bromage评分及术后不良反应。结果 CSEA组感觉阻滞起效时间为(40.0±12.0)s明显短于EA组的(260.0±60.0)s(P<0.01)。CSEA组局麻药用量明显少于EA组(P<0.01)。CSEA组所有患者对术中镇痛均感满意,EA组有11例患者对术中镇痛不满意,12例牵拉反应明显。肌松满意率CSEA组为100%,EA组为78%。2组患者均无明显的麻醉后并发症。结论腰-硬联合麻醉用于阴式全子宫切除手术,麻醉镇痛效果及肌松效果优于硬膜外麻醉。

Objective To assess the anesthetic effect of combined spinal-epidural anesthesia（CSEA） on vaginal hysterectomy.Methods 100ASA Ⅰ or Ⅱ patients aged 35～55 yr,undergoing vaginal hysterectomy were enrolled in this study.The patients were divided into 2 groups according to the methods of anesthesia（n=50 each）： CSEA group use the spinal-epidural anesthesia while EA group use the epidural anesthesia.Record the dosage of local anesthetic,the onset time of sensory block,the level of blockade,the complete block time,the algesia recovery time,the reform Bromage grade and the adverse effect after surgery.Results The onset time of sensory block in CSEA group was shorter than EA group（P0.01）,the dosage of local anesthetic in CSEA group was less than EA group（P0.01）.All of the patients in CSEA group were satisfied with the analgesia effect,while in EA group 11 patients were dissatisfied with the analgesia effect,12 patients have obviously traction reaction.Satisfactory rate of muscle relaxation in CSEA group was 100% while in EA group was 78%.None of the patients have the adverse effect after anesthesia.Conclusion Combined spinal-epidural anesthesia was superior to epidural anesthesia in analgesia effect and muscle relaxation effect on vaginal hysterectomy.